Endovascular treatment of aortic aneurysms: an initial single center experience

Introduction: The aneurysms of thoracic descending aorta (TAA) and abdominal aorta (AAA) become clinically relevant during acute vascular complications such as dissections or rupture. In these emergency clinical settings the peri-operative risk and morbi-mortality markedly increase. Early diagnosis and treatment of aortic aneurysms prior to becoming acutely complicated is still to be accomplished in modern cardiovascular medicine. While AAA are mainly due to atherothrombotic disease of the elderly, the etiology of TAA is much more different and comprises thoracic trauma, genetic anomalies of elastic tissue or severe hypertension. We present our experience with endovascular treatment of AAA and TAA with self-expandable Endurant and Valiant Captivia endovascular graft s (EVG). Methods: Between Sept 2012 – May 2014 we treated with EVG 8 patients (pts): 7 with AA (6 AAA and a TAA) and a type B acute aortic dissection with splanchnic vessel involvement with Endurant (AAA x 6) and Valiant Captivia (TAA x 2). Pts’ age was between 34 (type B aortic dissection) and 86 (AAA). All pts had hypertension and smoked; 2 pts had diabetes. All pts underwent angiography and angio CT to define the anatomy and establish EVG dimensions. The criteria for endovascular exclusion were: maximum diameter > 65 mm (TAA) and > 55 mm (AAA), proximal neck > 20 mm for TAA and >10 mm for AAA, and no severe calcification of iliac arteries. All procedures were performed under epidural anesthesia by surgical femoral access. In the TAA case and type B aortic dissection a pigtail cath was inserted by radial access. Results: All procedures were performed in the angiography room and allowed complete aneurysm exclusion. A single type A endoleak was observed in an AAA case with a sharply angulated infrarenal neck, that spontaneously resolved at angio CT after 6 months. Mean radioscopy time was 17:30 minutes. The mean contrast medium that was given was 125 ml. There were no intraprocedural or postoperative embolic events. In 4 cases we used a proximal “free-flow” EVG to cover major aortic branches. In the type B aortic dissection we performed a left carotid-subclavian by-pass and ligation of the left subclavian artery was done 48 h prior to EVG implantation. All cases were followed up by angio CT 6 months after the index procedure, to confirm complete and sustained exclusion of the AA. Conclusions: Endovascular treatment of aortic aneurysms is a safe and efficacious treatment alternative to surgical intervention. Endovascular or surgical treatment of AA must be decided depending on aortic anatomy and mainly to comorbidities that can impact on perioperative prognosis. The HeartTeam cooperation is essential even in these complex cases of vascular disease.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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