| Byoung-Keuk Kim¹, Boyoung Joung¹, Young-Guk Ko¹, Donghoon Choi¹, Yangsoo Jang¹, Byoung-Chul Chang² , Do-Youn Lee³, Won-Heum Shim¹ |
Background Although the standard management of abdominal aortic aneurysm(AAA) is surgery, the endovascular stent-graft treatment is more attractive for patients with significant co-morbid conditions. We evaluated the immediate and mid-term outcomes of the endovascular treatment of AAA. Methods Between November 1996 and June 2004, 59 patients with AAA(53 males, mean age 67.0±9.6 years, 3 cases with ruptured AAA) underwent an endovascular stent-graft repair at our institute. All patients were evaluated by an angiography, taken just after the completion of the procedure and followed up with computed tomography(CT) at 3 days and, 1, 6, 12months and yearly after implantation. Results The primary success was achieved in 54 of the 59 patients(91.5%). Periprocedural mortality rate was 3.4%. Primary endoleak was found in 14 patients(23.7%)(type I;10 patients, type II;3 patients, type III;1 patient): Three of them required subsequent surgical conversion. Spontaneous resolution was seen in 5 patients. Average follow-up period of 57 patients was 28.9 months(range from 55 days to 3970 days). Aneurysmal size on follow-up CT decreased or did not change in 49 patients(83.0%) (decreased size in 34 cases, no change in 15 cases). In 8 patients(13.5%), newly developed endoleak was documented. Cumulative event-free survival rate was 89.7% at 30 days, 74.5% at 1 year, and 55.8% at 2 years. Cumulative mortality rate was 8.6% at 30 days, 16.0% at 1 year, and 25.3% at 2 years. Total 15 patient(25.4%) died(rupture in 2 cases(13.3%), operation-related causes in 3 cases(20.0%), unknown causes in 7 cases(46.7%), unrelated causes in 3 cases(20.0%)) during overall follow-up. Secondary intervention was required in 12 patients(20.3%). Surgical conversion was required in 2 patients(3.4%). Conclusion The immediate and long-term results suggest that endovascular treatment of AAA is technically feasible and effective. There is higher mortality and morbidity in primary and newly developed endoleak cases. Therefore, regular follow-up is necessarily needed in all cases.
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