Repair of abdominal aortic aneurysms by the endoluminal method: Outcome in the first 100 patients

Objective: To report the outcome in our first 100 patients with abdominal aortic aneurysms repaired by the endoluminal method. Design: Analysis of concurrently collected data of patients undergoing repair of an aortic aneurysm. The technique involves the delivery of an endograft into the abdominal aorta by means of a sheath inserted through the femoral or iliac artery. Clinical examination and contrast-enhanced computed tomography (CT) were performed within 10 days, at six months and then annually after operation. Setting: Royal Prince Alfred Hospital, Sydney, a tertiary referral teaching hospital. Patients: 100 patients, seven women and 93 men, with a mean age of 70 years (range, 46-87), treated between May 1992 and December 1995. Because of comorbidities, 43 of the patients had been considered unsuitable for conventional open repair at other medical centres. Our criteria for inclusion were the presence of a 1.5-cm or greater segment of thrombus-free aorta between the lowermost renal artery and the commencement of the aneurysm, and iliac arteries allowing access to the aorta from the groin. Outcome measures: (i) Need to convert to open repair; (ii) damage to the arteries from sheath insertion; (iii) communication between the aneurysmal sac and the circulation; (iv) death within 30 days; (v) effect on aneurysmal diameter. Results: Endografts were successfully deployed in 88 patients. In the remaining 12 patients endoluminal repair was converted to open repair. There were five deaths within 30 days of the operation, including three in the failed group. Damage to the femoral or iliac arteries from sheath insertion occurred in five patients. These were repaired without the need to convert to open repair. No patients were lost to follow-up (62 patients have been followed up for at least six months). Contrast-enhanced computed tomography shows progressive diminution in maximal transverse diameter of the aneurysms with time, after successful exclusion of the aneurysmal sac from the general circulation. Conclusions: Endoluminal repair of abdominal aortic aneurysms is feasible and this method of repair is durable in mid-term follow-up.