Early Results of a New Treatment for Large Abdominal Aortic Aneurysms with Refractory Endoleaks: Combined Endovascular and Laparoscopic Endoleak Repair (CEALER)

Purpose: To investigate the feasibility of regional anesthesia for endovascular repair of abdominal aortic aneurysms (AAAs). Methods: Since February 1995, 21 patients (17 men and 4 women; median age 67 years, range 49 to 80) have been treated with endovascular technique for true infrarenal AAA using Mialhe Stentor bifurcated grafts. A single dose of spinal anesthesia combined with epidural anesthesia was used in all procedures. Electrocardiography and arterial blood pressure were monitored. Results: No cases of emboli, hematoma, or graft migration were seen, and there were no reoperations or conversions to open operation. Arterial blood pressure was stable at a satisfactory level from induction of anesthesia throughout the procedure, and there was no period of clinically significant hypotension during any implantation. One patient died on the second postoperative day from cardiac and renal insufficiency. Three endoleaks were observed during the procedure; one healed spontaneously within 5 weeks, and the other two were repaired by endovascular techniques after 1 and 4 months, respectively. During follow-up, one patient died at 6 months from pancreatic carcinoma. Conclusions: The application of regional anesthesia is feasible for endovascular treatment of AAA. The arterial blood pressure remained stable throughout the procedure, and all patients, with two exceptions, were mobilized on the first day and placed on a regular diet. Based on these early results, it appears that regional anesthesia is feasible, effective, and safe for endovascular AAA repair.

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Early results of endovascular aneurysm sealing with chimney grafts to treat juxtarenal and suprarenal abdominal aortic aneurysms

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.09.065 ◽

2019 ◽

Vol 70 (1) ◽

pp. 43-52 ◽

Cited By ~ 2

Author(s):

Katherine Stenson ◽

Benjamin Patterson ◽

Matthew Joe Grima ◽

Jorg de Bruin ◽

Peter Holt ◽

...

Keyword(s):

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Early Results ◽

Abdominal Aortic

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Emergency Treatment of Symptomatic or Ruptured Abdominal Aortic Aneurysms: The Role of Endovascular Repair

Journal of Endovascular Therapy ◽

10.1177/152660280200900411 ◽

2002 ◽

Vol 9 (4) ◽

pp. 449-457 ◽

Cited By ~ 60

Author(s):

Neval Yilmaz ◽

Noud Peppelenbosch ◽

Philippe W.M. Cuypers ◽

Alexander V. Tielbeek ◽

Luciën E.M. Duijm ◽

...

Keyword(s):

Endovascular Repair ◽

Open Surgery ◽

Treatment Protocol ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Intention To Treat ◽

Abdominal Aortic ◽

Management Protocol ◽

New Treatment ◽

Conventional Open Surgery

Purpose: To report the initial experience with endovascular aortic repair (EVAR) in patients with ruptured or symptomatic abdominal aortic aneurysms (AAA) and to compare the results with conventional open surgery. Methods: Between May 1999 and December 2001, 24 patients (21 men; mean age 75 years, range 56–89) with ruptured or symptomatic AAA underwent EVAR using a specially designed aortomonoiliac endograft. Six patients were selected based on device and operator availability; the subsequent 18 patients were treated under a modified management protocol that offered stent-graft repair to all symptomatic AAA patients. The results of this new treatment protocol were analyzed on an intention-to-treat basis for the last 8 months of the study. The 30-day outcomes in all patients treated with emergency EVAR were compared with 40 consecutive, contemporaneous patients undergoing open surgery for symptomatic or ruptured AAA. Results: No early conversions to open surgery were performed. Significantly decreased operative blood loss and intensive care stay (p<0.05 for both) were observed in EVAR patients. The mortality rate for EVAR patients was 17% compared to 32% in conventionally treated patients (NS). Among patients with ruptured AAA, the 30-day mortality rates were 24% (4/17) and 41% (12/29) for EVAR and open surgery, respectively (NS). Of 26 unselected patients who were treated prospectively under the modified protocol, the majority (81%, 21/26) had anatomy suitable for endovascular repair; however, only 18 (69%) underwent EVAR owing to a short infrarenal neck (n=2) or device/operator unavailability (n=6). Conclusions: EVAR is a feasible treatment in the majority of patients with ruptured or symptomatic AAA. The 30-day mortality appears to be similar between conventionally treated patients and those undergoing endovascular repair.

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