Endovascular Management of Inflammatory Abdominal
Grant T Fankhauser1, William M Stone1, Thomas C Bower2, Gustavo S Oderich2, W Andrew Oldenburg3, Samuel R Money1
1Mayo Clinic Arizona, Phoenix, AZ;2Mayo Clinic, Rochester, MN;3Mayo Clinic Florida, Jacksonville, FL
INTRODUCTION: Inflammatory abdominal aortic aneurysms (IAAA) have been traditionally managed with open repair. Endovascular repair of aortic aneurysms (EVAR) was approved September of 1999. Some authors have suggested EVAR is not an acceptable option for management of IAAA. However, several recent reports have suggested EVAR is a reasonable management option in these patients. The purpose of our study was to review our experience with the contemporary management of IAAA involving both open and endovascular approaches.
METHODS: A retrospective review of all patients undergoing repair of IAAA from 1999 - 2011 was conducted at three geographically separate institutions. Basic demographics, diagnostic work-up, treatment, and outcomes were reviewed.
RESULTS: Between 1999-2011 thirty-six patients underwent surgical repair of IAAA, 28 by open repair and 8 by EVAR. Eighty-three percent of patients were male with a mean age of 69. Aneurysm size was similar in both groups (6.2cm Open vs. 5.9cm EVAR). Average ICU stay in the open group was 2 days compared to zero in the EVAR group. Average hospital stay was 10 days in the open group and 2 days in the EVAR group (p<0.01). Follow-up for the open group was a mean of 1233 days and 753 days for the EVAR group. Periaortic fibrosis was documented to improve or resolve in all EVAR patients. Hydronephrosis was present preoperatively in 2 of 8 EVAR patients and improved in one of the two. Aneurysm size decreased in all EVAR patients by an average of 1.9 cm (19.8%). There were no aneurysm-related deaths or major morbidities in the EVAR group. Five patients (18%) in the open surgical group suffered major complications including myocardial infarction, renal failure, lower extremity amputation, sepsis, and prolonged ventilation.
CONCLUSIONS: Endovascular repair for IAAA results in successful management with decreased length of hospitalization, the potential for decreased morbidity, and equal resolution of periaortic inflammation. EVAR should be considered first-line therapy where anatomic parameters are favorable.
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