Initial experience with endovascular aneurysm repair: Comparison of early results with outcome of conventional open repair

D. C. Brewster, S. C. Geller, John Kaufman, R. P. Cambria, J. P. Gertler, G. M. LaMuraglia, S. Atamian, W. M. Abbott, R. M. Zwolak

Research output: Contribution to journalArticle

240 Citations (Scopus)

Abstract

Purpose: To determine the safety, effectiveness, and problems encountered with endovascular repair of abdominal aortic aneurysm (AAA). Initial experience with endoluminal stent grafts was examined and compared with outcome for a matched concurrent control group undergoing conventional operative repair of AAA. Methods: Over a 3-year period, 30 patients underwent attempts at endovascular repair of infrarenal AAA. Of the 28 (93%) successfully implanted endografts, 8 were tube endografts, 8 bifurcated grafts, and 12 aortouniiliac grafts combined with femorofemoral bypass. Most of the procedures were performed in the past year because the availability of bifurcated and aortoiliac endografts markedly expanded the percentage of patients with AAA who might be treated with endoluminal methods. The follow- up period ranged from 1 to 44 months, with a mean value of 11 months. Results: Endovascular procedures demonstrated significant advantages with respect to reduced blood loss (408 versus 1287 ml), use of an intensive care unit (0.1 versus 1.75 days), length of hospitalization (3.9 versus 10.3 days), and quicker recovery (11 versus 47 days). Although the total number of postoperative complications was identical for the two groups, the nature of the complications differed considerably. Local and vascular complications characteristic of endovascular repair could frequently be corrected at the time of the procedure and tended to be less severe than systemic or remote complications, which predominated among the open surgical repair group. On an intent-to-treat basis, 23 (77%) of the 30 AAAs were successfully managed with endoluminal repair. The seven (23%) failures were attributable to two immediate conversions caused by access problems, three persistent endoleaks, one late conversion caused by AAA expansion, and one late rupture. Conclusions: Although less definitive than those for conventional operations, these early results suggest that endovascular AAA repair offers considerable benefits for appropriate patients. The results justify continued application of this method of AAA repair, particularly in the treatment of older persons at high risk.

Original languageEnglish (US)
Pages (from-to)992-1005
Number of pages14
JournalJournal of Vascular Surgery
Volume27
Issue number6
DOIs
StatePublished - 1998
Externally publishedYes

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Abdominal Aortic Aneurysm
Aneurysm
Transplants
Endoleak
Endovascular Procedures
Angioplasty
Stents
Blood Vessels
Intensive Care Units
Rupture
Hospitalization
Safety
Control Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Initial experience with endovascular aneurysm repair : Comparison of early results with outcome of conventional open repair. / Brewster, D. C.; Geller, S. C.; Kaufman, John; Cambria, R. P.; Gertler, J. P.; LaMuraglia, G. M.; Atamian, S.; Abbott, W. M.; Zwolak, R. M.

In: Journal of Vascular Surgery, Vol. 27, No. 6, 1998, p. 992-1005.

Research output: Contribution to journalArticle

Brewster, DC, Geller, SC, Kaufman, J, Cambria, RP, Gertler, JP, LaMuraglia, GM, Atamian, S, Abbott, WM & Zwolak, RM 1998, 'Initial experience with endovascular aneurysm repair: Comparison of early results with outcome of conventional open repair', Journal of Vascular Surgery, vol. 27, no. 6, pp. 992-1005. https://doi.org/10.1016/S0741-5214(98)70002-3
Brewster, D. C. ; Geller, S. C. ; Kaufman, John ; Cambria, R. P. ; Gertler, J. P. ; LaMuraglia, G. M. ; Atamian, S. ; Abbott, W. M. ; Zwolak, R. M. / Initial experience with endovascular aneurysm repair : Comparison of early results with outcome of conventional open repair. In: Journal of Vascular Surgery. 1998 ; Vol. 27, No. 6. pp. 992-1005.
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abstract = "Purpose: To determine the safety, effectiveness, and problems encountered with endovascular repair of abdominal aortic aneurysm (AAA). Initial experience with endoluminal stent grafts was examined and compared with outcome for a matched concurrent control group undergoing conventional operative repair of AAA. Methods: Over a 3-year period, 30 patients underwent attempts at endovascular repair of infrarenal AAA. Of the 28 (93{\%}) successfully implanted endografts, 8 were tube endografts, 8 bifurcated grafts, and 12 aortouniiliac grafts combined with femorofemoral bypass. Most of the procedures were performed in the past year because the availability of bifurcated and aortoiliac endografts markedly expanded the percentage of patients with AAA who might be treated with endoluminal methods. The follow- up period ranged from 1 to 44 months, with a mean value of 11 months. Results: Endovascular procedures demonstrated significant advantages with respect to reduced blood loss (408 versus 1287 ml), use of an intensive care unit (0.1 versus 1.75 days), length of hospitalization (3.9 versus 10.3 days), and quicker recovery (11 versus 47 days). Although the total number of postoperative complications was identical for the two groups, the nature of the complications differed considerably. Local and vascular complications characteristic of endovascular repair could frequently be corrected at the time of the procedure and tended to be less severe than systemic or remote complications, which predominated among the open surgical repair group. On an intent-to-treat basis, 23 (77{\%}) of the 30 AAAs were successfully managed with endoluminal repair. The seven (23{\%}) failures were attributable to two immediate conversions caused by access problems, three persistent endoleaks, one late conversion caused by AAA expansion, and one late rupture. Conclusions: Although less definitive than those for conventional operations, these early results suggest that endovascular AAA repair offers considerable benefits for appropriate patients. The results justify continued application of this method of AAA repair, particularly in the treatment of older persons at high risk.",
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T2 - Comparison of early results with outcome of conventional open repair

AU - Brewster, D. C.

AU - Geller, S. C.

AU - Kaufman, John

AU - Cambria, R. P.

AU - Gertler, J. P.

AU - LaMuraglia, G. M.

AU - Atamian, S.

AU - Abbott, W. M.

AU - Zwolak, R. M.

PY - 1998

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N2 - Purpose: To determine the safety, effectiveness, and problems encountered with endovascular repair of abdominal aortic aneurysm (AAA). Initial experience with endoluminal stent grafts was examined and compared with outcome for a matched concurrent control group undergoing conventional operative repair of AAA. Methods: Over a 3-year period, 30 patients underwent attempts at endovascular repair of infrarenal AAA. Of the 28 (93%) successfully implanted endografts, 8 were tube endografts, 8 bifurcated grafts, and 12 aortouniiliac grafts combined with femorofemoral bypass. Most of the procedures were performed in the past year because the availability of bifurcated and aortoiliac endografts markedly expanded the percentage of patients with AAA who might be treated with endoluminal methods. The follow- up period ranged from 1 to 44 months, with a mean value of 11 months. Results: Endovascular procedures demonstrated significant advantages with respect to reduced blood loss (408 versus 1287 ml), use of an intensive care unit (0.1 versus 1.75 days), length of hospitalization (3.9 versus 10.3 days), and quicker recovery (11 versus 47 days). Although the total number of postoperative complications was identical for the two groups, the nature of the complications differed considerably. Local and vascular complications characteristic of endovascular repair could frequently be corrected at the time of the procedure and tended to be less severe than systemic or remote complications, which predominated among the open surgical repair group. On an intent-to-treat basis, 23 (77%) of the 30 AAAs were successfully managed with endoluminal repair. The seven (23%) failures were attributable to two immediate conversions caused by access problems, three persistent endoleaks, one late conversion caused by AAA expansion, and one late rupture. Conclusions: Although less definitive than those for conventional operations, these early results suggest that endovascular AAA repair offers considerable benefits for appropriate patients. The results justify continued application of this method of AAA repair, particularly in the treatment of older persons at high risk.

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