Endovascular Treatment of Abdominal Aortic Aneurysms in High-Surgical-Risk Patients Using Commercially Available Stent-Grafts

Abstract

To analyze the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk patients (i.e., age > or =80 years, serum creatinine level > or =3 mg/dL, severe pulmonary dysfunction, severe cardiac dysfunction). From April 2002 to June 2009, 50 consecutive high-surgical-risk patients (42 men; mean age 74.0+/-8.7, range 54-91) with an abdominal aortic aneurysm (AAA; mean diameter 64.8 mm) who were treated electively using a bifurcated aortic endograft (32 Excluder, 18 Zenith) were entered in a prospective registry. Thirty-five (70%) patients were classified ASA III and 15 (30%) were ASA IV. High-risk status was corroborated using the Customized Probability Index (CPI). Primary endpoints were operative mortality and long-term survival; secondary endpoints were the frequency of reintervention, evolution of the aneurysm sac, and rates of primary and secondary patency and rupture. The mean CPI score was 11.04+/-6.3. Operative mortality was 2% (1/50). There were 4 endoleaks, 1 case of endotension, and 1 endograft limb occlusion. Two patients required reintervention during the mean follow-up of 35.6 months. Survival at 3 years was 94%. Primary and secondary patency rates at 3 years were 98% and 100%, respectively. There were no ruptures. Initial and long-term results with endovascular treatment of AAA in high-surgical-risk patients were satisfactory and appear to justify this approach in this patient population.