Report of regional single center experience of endovascular abdominal aortic aneurysm repair at King Hussein Medical Center

Abstract EN

Objective : To present our experience with elective Endovascular Aneurysm Repair (EVAR) cases done at King Hussein Medical Center, Amman, Jordan.

Methods : This is a retrospective chart review of elective Endovascular Aneurysm Repair procedures done during the period of January 2004 to November 2010.

One hundred seventeen patients (91 males and 26 females) with a median age of 71 (range 52 to 79) successfully underwent the procedure.

Devices used included Endurant (Medtronic AVE, Santa Rosa, Calif), Zenith (Cook Inc, Bloomington, Ind), Talent (Medtronic), and Excluder (W.L.

Gore, Flagstaff, Ariz).

Configurations included, 113 (96.6 %) aorto-bi-iliac, three (2.6 %) aorto-uni-iliac with femoro-femoral crossover graft, and one (0.8 %) straight tube graft.

Most patients (n = 85, 72.6 %) scored 3 / 4 in the American Society of Anesthesia (ASA) scale and had significant comorbidities.

CT angiography was the main imaging modality used in both preplanning stage and follow up.

Primary outcome measures included overall mortality and freedom from aneurysm rupture.

Secondary outcome measures included access site complications, graft limb complications, and endoleaks.

Results : No conversions to open surgical repair or ruptures occurred post graft implantation.

A total of 14 (12.0 %) patients underwent re-intervention most of which were for access site problems.

These included wound hematoma treated conservatively (n = 5, 4.3 %), wound infection treated with drainage and antibiotics (n = 3, 2.6 %), and vessel dissection or occlusion needing surgical repair (n = 2, 1.7 %).

Graft limb complications included occlusions needing femoro-femoral bypass (n = 2, 1.7 %).

A total of 27 (23.0 %) endoleaks were diagnosed: three (2.6 %) were type I and were managed with ballooning and proximal extension in one case, 1(0.9 %) type 3 managed with an iliac limb extension, and 23 (19.7 %) type 2 endoleaks managed conservatively.

The mean in hospital length of stay (LOS) was 3.1 days (range 2-7) while the mean follow up was 16.2 months (range 6-58).

Overall patient mortality during the study period was eight (6.8 %) patients while in hospital mortality was four (3.4 %).

All late deaths were aneurysm unrelated.

Conclusion : Endovascular Aneurysm Repair is technically feasible and effective in aneurysm exclusion and preventing rupture.

It offers major advantages over open aneurysm repair including reduced early mortality, hospital stay, and use of intensive care facilities.

However, issues of cost effectiveness and late mortality in our setting are still to be resolved.