Endovascular stent graft applications in abdominal aortic aneurysm

Abdominal Aortic Aneurysm (AAA) is a permanent localized dilation of the abdominal aorta. Most patients with AAA are asymptomatic. The most common and feared complication of the AAA is rupture. Aneurysm size is one of the strongest predictors of the risk of rupture, with risk increasing markedly at aneurysm diameters greater than 5.5 cm. Mortality rates reach up to 90% in ruptured AAAs. However, mortality rate is about 5% in AAAs that are electively treated. Therefore, early detection and treatment of patients with AAAs before rupture is crucial for the prognosis. The options to repair AAAs include surgical or endovascular repair, which involves deployment of an endograft into the lumen to exclude the aneurysm from high pressure blood flow, therefore minimizing the risk of rupture. Endovascular stent graft implantation is accepted as a less invasive intervention for diseases of the abdominal aorta. Compared to surgery, it yields less perioperative blood loss, shorter duration of hospital stay, less perioperative mortality rates. Also, performing under local anesthesia and sedation are the advantages of endovascular stent graft implantation. Pre-treatment imaging is crucial for evaluating patient eligibility, selecting the appropriate stent graft and planning the intervention. Records of 73 male and 8 female patients aged between 51 to 89, who underwent endovascular repair due to abdominal aortic aneurysm or ruptured abdominal aortic aneurysm at Baskent University Faculty of Medicine Ankara Hospital Unit of Interventional Radiology from year 2004 to 2012 were retrospectively examined. Demographic data, preoperative aneurysm diameters, aneurysm neck diameter and angulation, size and type of the stent graft, successful device deployment rate, perioperative mortality rate (<30 days), aneurysm related mortality rate (<30 days), secondary endovascular interventions (during engraftment), complications and duration of hospitalization were recorded. In our study mean patient age was 70.17 years (range, 51-89 years); 90.1% were male. Technical success rate was 100% and none of the patient need surgical conversion. There were no aneurysm related mortality in 30 days period. Perioperative mortality rate (<30 days) was 16.6% in the ruptured AAA group (n=6). In the electively treated AAA group there were no perioperative mortality in 30 days period. Secondary intraprocedural endovascular interventions rate was 17.2%. Duration of hospitalization was 4.54 days in electively treated AAA group and 10 days in ruptured AAA group. In 81 patients, 24 endoleaks (29.6%) were detected. Most of the endoleaks were type 2. To conclude, our study shows endovascular treatment of AAA is a safe procedure that has high technical success rate. Especially in elderly and high risk patients, it reduces the perioperative mortality, aneurysm related mortality and duration of hospitalization.