A modular aortouniiliac endovascular stent-graft is a useful device for the treatment of symptomatic and ruptured infrarenal abdominal aortic aneurysms: one-year results from a multicentre study.

Abstract

Endovascular repair (EVAR) of acute symptomatic and ruptured abdominal aortic aneurysm (rAAA) can be difficult without a large stock of suitable graft sizes. We report a prospective European multicentre study of a modular aortouniiliac stent-graft. Seven centres, with elective EVAR experience, participated in the study. Sixty-five patients were enrolled from September 2002 - April 2005. Some 45 patients had rAAA and 20 were acutely symptomatic. Their median age was 74 (69-80.3) years, 49 (75%) were men. From a choice of 4 body and 4 limb sizes, stent-grafts were deployed under local or general anaesthesia. The endovascular delivery system was introduced and the aneurysm excluded from the circulation in a median of 40 (30-60) minutes from the first incision. The median operative duration was 150 (120-190) mins, blood loss 300 ml (200-800). 33 (51%) operations were performed by a vascular surgeon alone. There were a total of 4 (6%) peri-operative re-interventions, endovascular (n=1), open (n=2) and thrombectomy (n=1). The peri-operative mortality in the rupture group was 40% and 10% in the symptomatic group. Aortouniiliac stent-grafts provide rapid exclusion of rAAA. Suitably trained surgeons can do the operation without a radiologist's support. The mortality rate from rAAA treated with EVAR remains high.