Single center experience in endovascular aortic repair: review of technical and clinical aspects

Öz

Objective: The aim of this study is sharing of our endovascular aortic repair experiments in patients with high risk for surgery and contributing to literature with comparing previous report according to mortality complications and additional operations. Methods: Patients with endovascular aortic repair application were evaluated retrospectively. Perioperative one month mortality, additional applications during procedure, occurred complications, endoleak types, approaching anesthetical technique, diagnosis of disease, comorbid factors and demographical data registered. Results were compared with data in the literature Results: Abdominal endovascular aortic repair (EVAR) applicated into 19 patients. Thoracic endovascular aortic repair (TEVAR) applicated into 11 patients. EVAR patients were operated with diagnosis of abdominal aortic aneurysm. Nine of these patients were emergely operated due to rupture. TEVAR applicated 8 patients were operated due to Type 3 Aortic Dissection and 1 patient was operated due to transsection. One month mortality of all patients were found as 10% (three patients). Endoleaks were occurred 6 patients: Three of them were Type 1a, two of them were Type1b and one of them was Type2. Balloon angioplasty applicated in two patients due to Type 1a endoleak and, in one patient due to Type 1b endoleak. Chronic renal failure was developed in one patient (3.3%) due to contrast nephropathy. Reexploration was applicated in two patients (6.7%) due to hematoma. Conclusion: Endovascular techniques are become frequently preferred treatment modality with the developing technology. We believed that endovascular approaches are safely preferable alternative in patients with high surgical risk as our series.

Anahtar Kelimeler

• Aortic patologies, EVAR, TEVAR, clinical outcomes, application technique

Endovasküler aortik onarımda tek merkez deneyimi: Teknik ve klinik yönlerin incelenmesi

Öz

Amaç: Bu çalışmanın amacı; cerrahisi yüksek riskli aortik patolojiye sahip hastalarda uyguladığımız Endovasküler Aortik Onarım tecrübelerimizin paylaşılması ve önceki raporlarla; gelişen mortalite, komplikasyonlar, ek girişimler açısından kıyaslanarak literatüre katkı sağlanmasıdır. Yöntemler: Retrospektif olarak endovasküler aortik onarım uygulanan hastalar değerlendirildi. Perioperatif 1 aylık mortalite, prosedür esnasındaki ek girişimler, gelişen komplikasyonlar, endoleak tipleri, uygulanan anestezi yöntemi, hastalığın tanısı, komorbid faktörleri ve demografik veriler kaydedildi. Sonuçlar literatürdeki veriler ile karşılaştırıldı.Bulgular: Abdominal endovasküler aortik onarım (EVAR) 19 hastaya uygulandı. Torasik endovasküler aortik onarım (TEVAR) 11 hastaya uygulandı. EVAR hastaları abdominal aort anevrizma tanısı ile işleme alındı. Bu hastaların 9 ‘u rüptür nedeniyle acil olarak opere edildi. TEVAR uygulanan 8 hasta Tip 3 aort diseksiyonu, 1 hasta ise transeksiyon nedeniyle işleme alındı. Tüm vakaların 1 aylık mortalitesi % 10 ( 3 hasta) olarak bulundu. Endoleak gelişen 6 hastadan, 3 tanesi Tip1a, 2 tanesi Tip1 b ve 1 tanesi de Tip 2 idi. İki hastaya Tip1a ve 1 hastaya daTip1b endoleak nedeniyle balon anjioplasti yapıldı. Bir hastada postoperatif kontrast nefropatisine bağlı kronik böbrek yetmezliği(% 3,3) gelişti. Postoperatif dönemde hematom nedeniyle 2 (%6,7) hastada reeksplorasyon uygulandı.Sonuç: Endovasküler yöntemler aort patolojilerinde teknolojinin de ilerlemesiyle sıkça tercih edilen bir tedavi yöntemi haline gelmiştir. Bizim serimizde olduğu gibi cerrahi açıdan ciddi risk taşıyan hasta grubunda endovasküler yöntemlerin güvenle tercih edilebilecek bir alternatif olduğu kanaatindeyiz

Anahtar Kelimeler

• Aort patolojileri, EVAR, TEVAR, klinik sonuçlar, uygulama tekniği

Kaynakça

1. United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, Powell JT. et al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010;362:1863-1871.
2. Singh K, Bonaa KH, Jacobsen BK. et al. Prevalence of and risk factors for abdominal aortic aneurysms in a popula- tion-based study : The Tromso Study. Am J Epidemiol 2001;154:236-244.
3. Elefteriades JA, Farkas EA. Thoracic aortic aneurysm clini- cally pertinent controversies and uncertainties. J Am Coll Cardiol 2010;55:841-857.
4. Assar AN, Zarins CK. Ruptured abdominal aortic aneurysm: A surgical emergency with many clinical presentations. Postgrad Med J 2009;85:268-73.
5. Dubost C, Allary M, Oeconomos N. Treatment of aortic an- eurysms; Removal of the aneurysm; re-establishment of continuity by grafts of preserved human aorta. Mem Acad Chir 1951;77:381-383.
6. Volodos NL, Shekhanin VE, Karpovich IP. et al. A self-fixing synthetic blood vessel endoprosthesis. Vestn Khir Im I I Grek 1986;137:123-125.
7. Akin I, Kische S, Rehders TC. et al. Thoracic endovascular stent-graft therapy in aortic dissection. Curr Opin Cardiol 2010;25:552-559.
8. Swee W, Dake MD. Endovascular management of thoracic dissections. Circulation 2008 18;117:1460-1473.

9. Baril DT, Cho JS, Chaer RA, et al. Thoracic aortic aneurysms and dissections: endovascular treatment. Mt Sinai J Med 2010;77:256-269. doi: 10.1002/msj.20178.
10. Earnshaw JJ, Birch Ph. Interpretation of the Randomized EVAR Trials. Acta Chir Belg 2006,106,139-140.
11. de Donato G, Setacci F, Sirignano P. et al. Ultra-low profile Ovation device: is it the definitive solution for EVAR? J Cardiovasc Surg. 2014;55:33-40.
12. Brown LC, Powell JT, Thompson SG, et al. The UK En- doVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy. Health Technol As- sess 2012;16:1-218.
13. Cao CQ, Bannon PG, Shee R, et al. Thoracic endovascular aortic repair-indications and evidence. Ann Thorac Cardio- vasc Surg 2011;17:1-6.
14. Desai ND, Burtch K, Moser W, et al. Long-term compari- son of thoracic endovascular aortic repair (TEVAR) to open surgery for the treatment of thoracic aortic aneurysms. J Thorac Cardiovasc Surg 2012;144:604-9; discussion 609- 611.
15. Braverman AC. Acute aortic dissection: clinician update. Circulation 2010;122:184-188.
16. Hughes K1, Jackson JD, Prendergast TI, et al. Diabetes mellitus is not associated with major morbidity follow- ing open abdominal aortic aneurysm repair. J Surg Res 2013;184:751-754.
17. Sarac M, Marjanović I, Tomić A, et al. Endovascular repair of ruptured abdominal aortic aneurysm. Vojnosanit Pregl 2014;71:78-82.
18. Setacci F, Sirignano P, Kamargianni V, et al. Inguinal field block for femoral artery exposure during endovascular an- eurysm repair. J Endovasc Ther 2013;20:655-662.
19. Kim M, Brady JE, Li G. Anesthetic technique and acute kidney injury in endovascular abdominal aortic aneu- rysm repair. J Cardiothorac Vasc Anesth 2013:S1053- 0770(13)00356-X.
20. White SB, Stavropoulos SW. Management of endoleaks following endovascular aneurysm repair. Semin Intervent Radiol 2009;26:33-38.
21. Parmer SS, Carpenter JP, Stavropoulos SW, et al. Endole- aks after endovascular repair of thoracic aortic aneurysms. J Vasc Surg 2006;44:447-452.
22. Neuhauser B, Czermak BV, Fish J, et al. Type A dissection following endovascular thoracic aortic stent-graft repair. J Endovasc Ther 2005;12:74-81.