Matched-Pair Analysis of Conventional Versus Endoluminal AAA Treatment Outcomes During the Initial Phase of an Aortic

Abstract

l l Purpose: To investigate whether endovascular stent-grafts implanted during the early phase of an aortic endografting program have advantages over conventional surgical pro-cedures for treatment of infrarenal aortic aneurysm (AAA). Methods: In the first months of an endografting program, 37 patients (36 men; mean age 67.9 6 7.1 years, range 55 to 86) underwent AAA repair with endovascular implantation of a Vanguard (n 5 17) or Talent (n 5 20) bifurcated stent-graft. Data collected during the perioperative period and in follow-up were compared retrospectively to a matched group of 37 elective surgical patients. Results: All endograft implantations were completed. Two type I and 6 type II endoleaks (21.6%) were seen postoperatively. Five type II sealed without intervention; 1 type I en-doleak was corrected with an additional stent, but 1 type I and 1 type II endoleaks persisted despite attempts with coil embolization. Two (5.4%) endograft patients died during the perioperative period; however, this was not significantly different (p 5 0.15) from the con-trol group. In the mean follow-up of 12 6 6 months for both groups, 1 (2.7%) late conver-sion was necessary at 2 years for aneurysm expansion in an endograft patient with an unsealed type I endoleak. Conclusions: In our learning curve experience with aortic endografting, postoperative mor-bidity and mortality were higher in endograft patients compared to conventionally treated controls. Only in the endograft group was reoperation required during follow-up. Careful monitoring with periodic imaging studies is mandatory after endoluminal AAA treatment. J Endovasc Ther 2000;7:94–100 Key words: endovascular grafting, abdominal aortic aneurysm, aneurysm surgery, Van