Naše iskustvo u endovaskularnom liječenju aneurizme abdominalne aorte talent stent-graftom

The aim of the study was to evaluate the safety and efficacy of endovascular treatment of abdominal aorta aneurysm (AAA) with Talent stent-graft (TSG). From October 1999 to February 2002, 18 patients (17 male and one female) aged 65-77, with AAA >5 cm in diameter, were treated by bifurcated Talent stent grafting. In all patients, postinterventional CT was performed 24 hours after stent grafting. The sutures were removed on the seventh to ninth day after the procedure, and the patients were released for home care. Regular spiral CT control evaluation was scheduled at 1, 3, 6, 9, 12 and 24 months after stent grafting. The mean follow up time was 11 months. Talent stent grafting procedure was initially successful in all patients. During regular controls, the TSGs were not occluded. In two (11%) patients, Talent stent grafting was preceded by preinterventional embolization. In five (27%) patients, control spiral CT after stent grafting showed a small endoleak. In these patients, systemic heparinization was interrupted and spiral CT was repeated after seven days. Repeat spiral CT after seven days showed absence of endoleak in four of five (80%) patients. A small endoleak in one patient disappeared spontaneously a month after TSG placement. The mean annual reduction in aneurysmal sac diameter was 7.3 (0 to 28) mm. TSG placement is a safe and efficient method of AAA treatment. In patients with accurately determined indication for the procedure, it is today considered a justified alternative to surgery.Cilj rada bio je procijeniti sigurnost i učinkovitost endovaskularnog liječenja aneurizme abdominalne aorte (AAA) talent stent-graftom (TSG). Od listopada 1999. do veljače 2002. godine 18 bolesnika (17 muškaraca i jedna žena) životne dobi između 65 i 77 godina s AAA promjera >5 cm liječeno je postavljanjem bifurkacijskog TSG. U svih bolesnika poslijeintervencijski CT rađen je 24 sata nakon intervencije. Sedmog do devetog poslije intervencijskog dana skinuti su šavi i bolesnici su otpušteni na kućnu njegu. Redoviti kontrolni pregledi provedeni se spiralnim CT-om, i to 1., 3., 6., 9., 12. i 24. mjeseca nakon postavljanja TSG. Srednje vrijeme praćenja iznosilo je 11 mjeseci. U svih bolesnika postignut je primarni uspjeh, a na kontrolnim pregledima TSG je bio prohodan. U dvoje (11%) bolesnika prije postavljanja TSG napravljene su prije intervencijske embolizacije. U petoro (27%) bolesnika na poslijeintervencijskom CT-u bilo je vidljivo manje endopropuštanje. U tih bolesnika ukinuta je sistemska heparinizacija i na spiralnom CT-u ponovljenom nakon sedam dana u četvoro od pet (80%) bolesnika endopropuštanja više nije bilo. U jednog je bolesnika manje endopropuštanje spontano prestalo mjesec dana nakon postavljanja TSG. Srednje smanjenje promjera aneurizmatske vreće iznosilo je 7,3 mm (0-28 mm) na godinu. Postavljanje TSG predstavlja sigurnu i učinkovitu metodu liječenja AAA. U bolesnika s pravilno postavljenom indikacijom danas se opravdano smatra alternativnom metodom kirurškom liječenju