Endovascular Treatment of Abdominal Aortic Aneurysms Should Not Be Denied to High-Surgical-Risk Patients

Abstract

To analyze the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk patients (i.e., age ≥ 80 years, serum creatinine level ≥ 3 mg/dL, severe pulmonary dysfunction, severe cardiac dysfunction) with favorable anatomy (ie, proximal neck length of at least 15mm, proximal neck angulation < 60°, absence of thrombus in the proximal neck). From April 2002 to November 2012, 80 consecutive high-surgical-risk patients (65 men; mean age 74 years, range 54-91 years) with an abdominal aortic aneurysm (AAA; mean diameter 66.6 mm) who were treated electively using a bifurcated aortic endograft (39 Excluder, 40 Zenith, 1 Endurant) were entered in a prospective registry. Fifty-five (68.7%) patients were classified ASA III and 25 (31.3%) were ASA IV. High-surgical-risk status was corroborated using the validated Customized Probability Index score. All patients used statins and betablockers in the perioperative period. Primary end points were operative mortality and long-term survival; secondary end points were the frequency of reintervention, evolution of the aneurysm sac, rates of primary and secondary patency and rupture. The mean Customized Probability Index score in our patients was 12.1. Operative mortality was 1.25% (1/80). There were 5 endoleaks and 2 endograft limb occlusions. Four patients required reintervention during the mean follow-up of 35.9 months. Survival at 3 years was 91.25%. Primary and secondary patency rates at 3 years were 97.5% and 100%, respectively. There were no ruptures. Our initial and long-term results with EVAR in high-risk patients were satisfactory and appear to justify this approach in this patient population. The most important factor for improvement of the short and long-term results of aortic endografts is respect of anatomic feasibility conditions.