Endovascular repair of abdominal aortic aneurysms: eligibility rate and impact on the rate of open repair.

OBJECTIVE The purpose of this study was to determine the rate of eligibility among patients with abdominal aortic aneurysms (AAAs) considered for endovascular repair and to examine the effect of an endovascular program on the institutional pattern of AAA repair. METHODS All patients evaluated for endovascular AAA repair since the inception of an endovascular program were reviewed for determination of eligibility rates and eventual treatment. Open AAA repairs were categorized as simple (uncomplicated infrarenal), complex (juxtarenal, suprarenal, thoracoabdominal, infected), or ruptured, and their rates before and after initiation of an endovascular program were compared. RESULTS Over 3 years, 324 patients were considered for endovascular AAA repair; 176 (54%) were candidates, 138 (43%) were not candidates, and 10 (3%) did not complete the evaluation. The rate of eligibility increased significantly from 45% (66/148 patients) during the first half of this period to 63% (110/176 patients) during the second half (P <. 001). Candidates were significantly younger (74.4 +/- 7.6 years) than noncandidates (78.3 +/- 6.7 years) (P <.01), and their aneurysm diameter tended to be smaller (57.6 +/- 9.2 mm compared with 60.8 +/- 12.3 mm; P =.06). The most common reason for ineligibility was an inadequate proximal aortic neck. Of 176 candidates, 78% underwent endovascular repair, and 6% underwent open repair. Of 138 noncandidates, 56% underwent surgical repair. Over a period of 6 years, 542 patients with AAAs (429 simple, 86 complex, 27 ruptured) underwent open repair. The total number and ratio of simple to complex open repairs for nonruptured aneurysms during the 3 years before the initiation of the endovascular program (213 simple, 44 complex) were not significantly different from the repairs over the subsequent 3-year period (216 simple, 42 complex). Similarly, no difference in the total number and the ratio of simple to complex open repairs was found between the first and the second 18-month periods since the initiation of the endovascular program. CONCLUSIONS The rate of eligibility of patients with AAA for endovascular repair appears to be higher than previously reported. The presence of an active endovascular program has not decreased the number or shifted the distribution of open AAA repair.

[1]  J M Jausseran,et al.  Morphologic assessment of abdominal aortic aneurysms by spiral computed tomographic scanning. , 1997, Journal of vascular surgery.

[2]  R. Green,et al.  Infrarenal aortic aneurysm structure: implications for transfemoral repair. , 1994, Journal of vascular surgery.

[3]  J. Lammer,et al.  Treatment of abdominal aortic aneurysms with transfemoral placement of stent-grafts: complications and secondary radiologic intervention. , 1997, Radiology.

[4]  J. Oestmann,et al.  Infrarenal abdominal aortic aneurysms: implications of CT evaluation of size and configuration for placement of endovascular aortic grafts. , 1996, Radiology.

[5]  J. Kaufman,et al.  Initial experience with endovascular aneurysm repair: comparison of early results with outcome of conventional open repair. , 1998, Journal of vascular surgery.

[6]  F. Prendergast,et al.  The Perth HLB bifurcated endoluminal graft: a review of the experience and intermediate results. , 1998, Cardiovascular surgery.

[7]  W S Moore,et al.  Repair of abdominal aortic aneurysm by transfemoral endovascular graft placement. , 1994, Annals of surgery.

[8]  R Stokking,et al.  Computed tomographic angiographic imaging of abdominal aortic aneurysms: implications for transfemoral endovascular aneurysm management. , 1997, Journal of vascular surgery.

[9]  F Beyersdorf,et al.  Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. , 1997, The New England journal of medicine.

[10]  L. Hollier,et al.  Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms. , 1998, Journal of vascular surgery.

[11]  W. Edwards,et al.  An assessment of the current applicability of the EVT endovascular graft for treatment of patients with an infrarenal abdominal aortic aneurysm. , 1999, Journal of vascular surgery.

[12]  H H Eckstein,et al.  Morphometry and Classification in Abdominal Aortic Aneurysms: Patient Selection for Endovascular and Open Surgery , 1997, Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery.