Anatomical feature and early outcomes of endovascular aneurysm repair from King Chulalongkorn Memorial Hospital
Keywords:
Abdominal aortic aneurysm, anatomical feature, Asian population, endovascular aneurysm repairAbstract
Background: Many studies have evaluated anatomy of infrarenal abdominal aortic aneurysm (AAA) and outcomes after endovascular abdominal aneurysm repair (EVAR) but mostly in non-Asian populations. The objective of this study was to evaluate anatomical features and early outcomes for EVAR in the Thai population in a single-center experience.
Objective: Treatment of AAA with suitable anatomy has been trending towards EVAR. This study aimed to analyze anatomical features and early outcomes of EVAR in Thai population at King Chulalongkorn Memorial Hospital (KCMH).
Methods: Retrospective review of 82 patients who underwent EVAR since January 2012 to December 2016. The medical records were analyzed for demographic data, anatomical features of AAA and outcomes in 30 days.
Results: Presentations were asymptomatic 38 cases (46.0%), symptomatic 19 cases (23.0%), ruptured AAA 13 cases (16.0%), and mycotic aneurysm 12 cases (15.0%). Anatomical features of the neck and aortic aneurysms in all groups were similar. Overall mortality was found 7 cases (8.5%). The ruptured group had a significantly higher mortality rate 4 cases (30.0%).
Conclusion: Anatomical features of AAA at KCMH were similar to other Asian populations. Early outcome of EVAR in asymptomatic, symptomatic, and mycotic aortic aneurysm was good. Thirty-day mortality was higher in ruptured AAA patients. Emergency and urgency conditions to treat AAA did not affect procedure-related complications. Iliac limb stent graft occlusion tends to occur in distal landing zone in the external iliac artery.
Downloads
References
Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491-9. https://doi.org/10.1007/BF02015271
Investigators IT, Powell JT, Sweeting MJ, Thompson MM, Ashleigh R, Bell R, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 2014;348:f7661. https://doi.org/10.1136/bmj.f7661
Sorelius K, Wanhainen A, Furebring M, Bjorck M, Gillgren P, Mani K, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation 2016;134:1822-32. https://doi.org/10.1161/CIRCULATIONAHA.116.024021
Kwon H, Lee DY, Choi SJ, Park KH, Min SK, Chang JH, et al. Anatomical features and early outcomes of endovascular repair of abdominal aortic aneurysm from a Korean Multicenter Registry. Vasc Specialist Int 2015;31:87-94. https://doi.org/10.5758/vsi.2015.31.3.87
Soden PA, Zettervall SL, Ultee KH, Darling JD, Buck DB, Hile CN, et al. Outcomes for symptomatic abdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program. J Vasc Surg 2016;64:297-305. https://doi.org/10.1016/j.jvs.2016.02.055
Kritpracha B, Premprabha D, Sungsiri J, Tantarattanapong W, Rookkapan S, Juntarapatin P. Endovascular therapy for infected aortic aneurysms. J Vasc Surg 2011;54:1259-65.
https://doi.org/10.1016/j.jvs.2011.03.301
Clough RE, Black SA, Lyons OT, Zayed HA, Bell RE, Carrell T, et al. Is endovascular repair of mycotic aortic aneurysms a durable treatment option? Eur J Vasc Endovasc Surg 2009;37:407-12.
https://doi.org/10.1016/j.ejvs.2008.11.025
Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011;41(Suppl 1):S1-58. https://doi.org/10.1016/j.ejvs.2010.09.011
Cheng SW, Ting AC, Ho P, Poon JT. Aortic aneurysm morphology in Asians: features affecting stent-graft application and design. J Endovasc Ther 2004;11:605-12. https://doi.org/10.1583/04-1268R.1
Zarkowsky DS, Hicks CW, Bostock IC, Stone DH, Eslami M, Goodney PP. Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair. J Vasc Surg 2016;64:1278-85 e1. https://doi.org/10.1016/j.jvs.2016.04.009
Saratzis A, Nduwayo S, Sarafidis P, Sayers RD, Bown MJ. Renal function is the main predictor of acute kidney injury after endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 2016;31:52-9.
https://doi.org/10.1016/j.avsg.2015.10.010
Bastos Goncalves F, Verhagen HJ, Vasanthananthan K, Zandvoort HJ, Moll FL, van Herwaarden JA. Spontaneous delayed sealing in selected patients with a primary type-Ia endoleak after endovascular aneurysm repair. Eur J Vasc Endovasc Surg 2014;48:53-9. https://doi.org/10.1016/j.ejvs.2014.01.018
Faure EM, Becquemin JP, Cochennec F, collaborators E. Predictive factors for limb occlusions after endovascular aneurysm repair. J Vasc Surg 2015;61:1138-45 e2.
Daoudal A, Cardon A, Verhoye JP, Clochard E, Lucas A, Kaladji A. Sealing zones have a greater influence than iliac anatomy on the occurrence of limb occlusion following endovascular aortic aneurysm repair. Vascular 2016;24:279-86. https://doi.org/10.1177/1708538115591940
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Chulalongkorn Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.