External transabdominal manipulation of vessels: a useful adjunct with endovascular abdominal aortic aneurysm repair

During endovascular abdominal aortic aneurysm repair, a severely angulated aortic neck or tortuous iliac arteries can make delivery of endografts difficult. We describe a simple adjunct in which transabdominal manipulation of vessels is used, which can greatly facilitate delivery of these devices in patients with challenging anatomy.     

Aorto-duodenal fistula on an aortic endograft: a rare cause of late conversion after endovascular aneurysm repair

The last few years have seen an increase in popularity of endovascular aneurysm repair because of the improvements made to the endografts design as well as experience gained by physicians, but the long-term results of this procedure are still uncertain. The majority of late complications after an endograft can be treated with an endovascular approach but, in some cases, it may need conversion to open surgery. In this paper, we discuss the case of a male patient who presented with an aorto-duodenal fistula on an endograft requiring explant. After two operations and 20 days in hospital, the patient was discharged and after 1 year he is doing well. In medical literature, there are very few reported cases of aortoenteric fistula complicating endovascular prosthesis, the diagnosis is quite difficult, surgical treatment is fairly complex consisting in endograft removal and we refer to our experience on this difficult and life-threatening operation.     

Acute and chronic open conversion after endovascular aortic aneurysm repair: a 14-year review

OBJECTIVE: This study reviewed outcomes of patients requiring surgical conversion after endovascular abdominal aortic aneurysm (AAA) repair. METHODS: Records for all patients undergoing open conversion after endovascular AAA repair were reviewed. RESULTS: From 1993 to 2006, 574 patients underwent endovascular repair for AAA. Seventeen patients, including three patients who underwent prior endovascular repair at other centers, required surgical conversion with complete (n = 9) or partial graft removal (n = 8). Five patients required immediate conversion (acute), and 12 underwent delayed conversion 4 to 72 months after endovascular repair. Indications for acute conversion were large type I endoleak (n = 3, 60%), including one patient with graft migration, and retroperitoneal bleeding (n = 2, 40%). Indications for chronic conversion were endoleak with increasing aneurysm size (n = 9, 75%), stent fracture without endoleak (n = 1, 8%), delayed retroperitoneal bleeding (n = 1, 8%), and infection (n = 1, 8%). Suprarenal aortic cross-clamping was required in two patients (12%), and endograft components were retained in eight (47%). An aortic occlusion balloon placed through the body of the existing endograft facilitated proximal control in three patients. There were two perioperative deaths in the acute conversion group (2/5; 40%) and none in the delayed conversion group (P = .04). Five-year actuarial survival was 71.9%. Mean follow-up was 41.6 +/- 32.2 months. Retained endovascular components in patients with partial graft removal remained stable during follow-up. CONCLUSIONS: Surgical conversion after endovascular AAA repair can be performed without suprarenal clamping in most patients. Endovascular aortic control with a balloon avoids suprarenal exposure. Partial endograft removal in selected patients facilitates open conversion and appears durable. Acute conversion is associated with increased mortality.     

Open aneurysm repair in elderly patients not candidates for endovascular repair (EVAR): Comparison with patients undergoing EVAR or preferential open repair

The authors reviewed a 2-year experience with abdominal aortic aneurysm (AAA) repair to determine if patients who were excluded from endovascular aneurysm repair (EVAR) because of anatomic criteria (Group III) represented a higher risk for subsequent open aneurysm repair than either patients undergoing EVAR (Group II) or those patients who preferentially underwent open repair (Group I). Between January 2001 and December 2003, 107 patients underwent AAA repair. Open repair was recommended in patients <70 years of age and without significant comorbidities (Group I). There were 35 patients in Group I; 72 patients were evaluated for EVAR; 29 patients underwent EVAR (Group II), and 43 were excluded and underwent open repair (Group III). Exclusion criteria were those recommended by the graft manufacturers. Patients in Group I were significantly younger than those in Groups II and III (p < 0.0001). Gender, incidence of diabetes, and hypertension were similar in all groups. Patients in Group III had a greater incidence of coronary artery disease (CAD) than those in Groups I and II, trending toward statistical significance (p = 0.06). Aneurysm size in Group II was statistically smaller than in Group I or III. Group III had significantly more complications (25.6% vs 5.7% and 6.9%) than either Group I or II (p < 0.015). Cardiac complications were similar in all groups. Three patients in Group III required prolonged intubation and 3 in Group III developed renal insufficiency. A history of CAD was predictive of complications (21.8% vs 5.8%, p < 0.024), as was inclusion in Group III. There were 2 deaths in this series, both in Group III. Length of stay was significantly less in Group II (4.17 +/-2.36 days) than in Group I (6.57 +/-1.84 days) or Group III (12.30 +/-9.82 days) (p = 0.0001). Open aneurysm repair can be safely performed in younger good-risk patients (Group I) with results equivalent to EVAR (Group II) but with slightly longer length of stay (LOS). In older patients with suitable anatomy EVAR can be performed with minimal morbidity and short LOS. Older patients not suitable for EVAR (Group III) constitute a higher risk group of patients because of increased incidence of CAD and the need for more complex repairs. However, the mortality rate in this group was only 4.6%.     

Morphologic changes and outcome following endovascular abdominal aortic aneurysm repair as a function of aneurysm size

HYPOTHESIS: Small infrarenal abdominal aortic aneurysms have a more favorable clinical and morphologic outcome compared with medium and large abdominal aortic aneurysms following endovascular aneurysm repair(EVAR). DESIGN: A prospective clinical series of 206 patients undergoing elective EVAR between 1996 and 2001. SETTING: A tertiary care academic health center. PATIENTS: Patients were grouped according to aneurysm size: small (<50 mm), medium (50-60 mm), and large (>60 mm). INTERVENTIONS: Primary EVAR and secondary procedures to secure fixation of the stent graft and surgical conversions. MAIN OUTCOME MEASURES: Aneurysm diameter, endoleaks, and long-term morphologic changes were analyzed postoperatively with 3-dimensional reconstructions of computed tomographic angiograms. RESULTS: Groups were similar in age, comorbidities, and follow-up (mean +/- SD, 32.1 +/- 11.8 months). There were 30 small aneurysms, 92 medium aneurysms, and 84 large aneurysms, with a mean size of 45.1 +/- 3.7 mm, 53.8 +/- 3.1 mm, and 66.1 +/- 6.8 mm, respectively (P<.01). There was no significant difference in proximal neck or iliac artery diameter among the 3 groups. The proximal aortic neck length (28.1 +/- 11.6 mm [small]; 23.9 +/- 11.3 mm [medium]; and 22.1 +/- 11.6 mm [large]; P<.05) was significantly shorter in large aneurysms. Furthermore, there was a significant increase (6% [small]; 15% [medium]; and 21% [large]; P<.05) in angulated necks in large aneurysms. Following treatment, aneurysm diameter remained stable in most patients (83% [small]; 82% [medium]; and 83% [large]), with a mean decrease of 2.0 +/- 6.5 mm, 2.1 +/- 6.1 mm, and 3.7 +/- 7.7 mm in each group, respectively (P =.45). There was no difference in the incidence of endoleaks, aneurysm contraction, or aneurysm expansion based on preoperative aneurysm diameter. Secondary procedures were performed in 5 (20%) of 25, 9 (5.2%) of 170, and 5 (36%) of 11 aneurysms that contracted, remained stable, or expanded, respectively, following EVAR (P<.05). CONCLUSIONS: There is a 15% increase in neck angulation and a 27% decrease in neck length in large compared with small infrarenal abdominal aortic aneurysms, with no difference in outcome. Aneurysms that are stable following EVAR have a significantly lower incidence of requiring secondary procedures.     

Elective treatment of abdominal aortic aneurysm with endovascular or open repair: the first decade

OBJECTIVES: The development of endovascular aneurysm repair (EVAR) as an alternative to open repair of abdominal aortic aneurysms (AAA) has led to an increasing number of patients being treated by this less-invasive technique. It was anticipated that EVAR would reduce the operative mortality and morbidity compared with open repair. This study examined the initial 10-year experience in one center when both techniques were available to determine if there were advantages to one technique or the other, putting the results into the perspective of routine clinical care of patients with infrarenal AAA. METHODS: From June 1996 to May 2005, 677 patients underwent elective repair of their infrarenal AAA, of which 417 were treated with open repair and 260 by EVAR. Demographic and aneurysm-specific data, comorbidities, operative morbidity, mortality, and late outcome were analyzed. RESULTS: Open repair patients were 2 years younger (71 vs 74 years, P < .001), had larger aneurysms (6.01 +/- 1.38 cm vs 5.45 +/- 0.99 cm, P < .001), greater familial predisposition, a higher incidence of current smokers, and a higher incidence of chronic obstructive pulmonary disease than the EVAR group. There were no differences in renal function, hypertension, coronary artery disease, or heart failure between the two groups. Overall operative mortality was 3.1%; operative mortality per group was 3.5% for open and 2.7% for EVAR (P = .627). Procedure-related outcomes showed significant differences in operative blood loss and length of hospital stay in favor of EVAR, and 95% of the EVAR patients were discharged home vs 83% in the open repair group (P < .001). A Kaplan-Meier log-rank analysis showed no difference in early or long-term survival between open repair and EVAR (P = .20), but did show a difference in mid-term (3-year) survival favoring open repair (P < .002). Survival analysis by age (<70 and > or =70 years) showed no difference between treatment groups. CONCLUSIONS: Open repair and EVAR are both performed safely in patients treated for elective infrarenal AAA. EVAR has the perioperative advantages of reduced blood loss, reduced length of intensive care unit and hospital stay, and increased number of patients discharged to home. The mid-term survival advantage of open repair has been observed in other reports and deserves further study.     

Cost disparity between open repair and endovascular aneurysm repair for abdominal aortic aneurysm: a single-institute experience in Japan

Purpose

We conducted this study to compare the cost of open surgical repair (OR) with that of endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA).

Methods

Between January 2007 and November 2008, 70 patients underwent open repair and 57 patients underwent EVAR. We evaluated the total cost, including that of the Diagnosis Procedure Combination (DPC), that of the surgical procedure, that of materials such as grafts and guide wires, and that of the anesthesia.

Results

The mean costs for OR versus EVAR were as follows: DPC, ??632370 versus ??490050, respectively, which was significant; anesthesia, ??123540 versus ??86220, respectively (P?Conclusions New technologies should not only be clinically effective, but also cost effective. EVAR is less invasive clinically, but the cost of endovascular prostheses and other materials remains high.     

Functional status as a predictor of outcomes in open and endovascular abdominal aortic aneurysm repair

Background

Functional status is a simple and rapidly assessable metric that may be used as a predictor for surgical outcomes. This study examined the association of functional status with short-term mortality after abdominal aortic aneurysm (AAA) repair in octogenarians to characterize the utility of functional status as a means of preoperative risk assessment.

Randomized multicenter trial on percutaneous versus open access in endovascular aneurysm repair (PiERO)

BackgroundIn endovascular valve and aortic repair, vascular access through a percutaneous approach has become the competing technique to an open surgical approach. The effect on postoperative complications and surgical site infections (SSIs) has been investigated, but randomized evidence is lacking. The objective was to investigate whether percutaneous access of the common femoral artery (CFA) with a percutaneous closure device would decrease the number of SSIs compared with open surgical access of the CFA in endovascular aneurysm repair (EVAR).MethodsPatients with an abdominal aortic aneurysm suitable for EVAR were randomized to open or percutaneous access of the main device (MD) through the CFA. Through the contralateral side, access was obtained with the other technique than the one for which the MD was randomized. The primary outcome was number of SSIs. Secondary outcomes were wound complications, visual analog scale for pain scores, and standardized wound assessment scores during follow-up. Preoperative screening culture and groin biopsy specimens were obtained from all patients.ResultsBoth groups contained 137 groins. SSI rate was 1.5% in the open group vs 0% in the percutaneous group. For MDs only, SSI rate was 3.1% (odds ratio, 3.3; 95% confidence interval, 0.31-347; P = .34). Wound complications were comparable in both groups. Neither nasal nor groin Staphylococcus aureus carriage had a significant effect on SSIs, Southampton Wound Assessment score, or visual analog scale score. Adjusted pain score was 0.69 lower, in favor of percutaneous access. Wound assessment was better after 2 weeks (odds ratio, 3.57; 95% confidence interval, 1.02-12.44; P = .046), also in favor of percutaneous access.ConclusionsPercutaneous access of the CFA does not reduce the number of SSIs. It does, however, reduce pain and improve wound healing with less inflammation 1 day and 2 weeks after EVAR, respectively.     

Outcomes following endovascular abdominal aortic aneurysm repair (EVAR): an anatomic and device-specific analysis

OBJECTIVE: We performed a device-specific comparison of long-term outcomes following endovascular abdominal aortic aneurysm repair (EVAR) to determine the effect(s) of device type on early and late clinical outcomes. In addition, the impact of performing EVAR both within and outside of specific instructions for use (IFU) for each device was examined. METHODS: Between January 8, 1999 and December 31, 2005, 565 patients underwent EVAR utilizing one of three commercially available stent graft devices. Study outcomes included perioperative (< or =30 days) mortality, intraoperative technical complications and need for adjunctive procedures, aneurysm rupture, aneurysm-related mortality, conversion to open repair, reintervention, development and/or resolution of endoleak, device related adverse events (migration, thrombosis, or kinking), and a combined endpoint of any graft-related adverse event (GRAE). Study outcomes were correlated by aneurysm morphology that was within or outside of the recommended device IFU. chi2 and Kaplan Meier methods were used for analysis. RESULTS: Grafts implanted included 177 Cook Zenith (CZ, 31%), 111 Gore Excluder (GE, 20%), and 277 Medtronic AneuRx (MA, 49%); 39.3% of grafts were placed outside of at least one IFU parameter. Mean follow-up was 30 +/- 21 months and was shorter for CZ (20 months CZ vs 35 and 31 months for GE and MA, respectively; P < .001). Overall actuarial 5-year freedom from aneurysm-related death, reintervention, and GRAE was similar among devices. CZ had a lower number of graft migration events (0 CZ vs 1 GE and 9 MA); however, there was no difference between devices on actuarial analysis. Combined GRAE was lowest for CZ (29% CZ, 35% GE, and 43% MA; P = .01). Graft placement outside of IFU was associated with similar 5-year freedom from aneurysm-related death, migration, and reintervention (P > .05), but a lower freedom from GRAE (74% outside IFU vs 86% within IFU; P = .021), likely related to a higher incidence of graft thrombosis (2.3% outside IFU vs 0.3% within IFU; P = .026). The differences in outcome for grafts placed within vs outside IFU were not device-specific. CONCLUSION: EVAR performed with three commercially available devices provided similar clinically relevant outcomes at 5 years, although no graft migration occurred with a suprarenal fixation device. As anticipated, application outside of anatomically specific IFU variables had an incremental negative effect on late results, indicating that adherence to such IFU guidelines is appropriate clinical practice.     

腹主动脉瘤开腹手术与腔内修复术围手术期情况的荟萃分析

目的 评价国内腹主动脉瘤(AAA)开腹手术与腔内修复术围手术期情况.方法 检索2000年1月-2009年1月国内临床中心以中英文公开发表的AAA开腹手术与腔内修复术围手术期情况的非随机对照(NRCs)研究文献,提取相关指标后综合分析.结果 6篇NRCs资料质量评分为18.83±0.98.与开腹手术相比,腔内修复术术中失血量(WMD=-689.24 mL,95%CI为-1 077.61～-300.88,P＜0.05),术中输血量(WMD=-440.01 mL,95%CI为-488.96～-391.06,P＜0.05),术后禁食时间(WMD=-5.21 d,95% CI 为-6.23～-4.19,P＜0.05),术后ICU观察时间(WMD=-1.79 d,95% CI 为-2.21～-1.46,P＜0.05),术后住院时间(WMD:-5.19 d,95% CI 为-7.09～-3.28,P＜0.05)均显著减少.两种治疗方法 的手术时间(WMD=-35.86 min,95% CI 为-85.01～1 3.28,P=0.15)及并发症发生率(OR=0.92,95% CI 为0.55～1.53,P=0.74)差异无统计学意义.结论 国内NRCs资料的荟萃分析显示,腔内修复治疗AAA较开腹手术具有创伤小、失血少、术后恢复快的优点,但在手术时间及减少近期并发症方面无显著优势.     

Renal response to open and endovascular repair of abdominal aortic aneurysm: a prospective study

Because of incompatible reports about the renal impairment to abdominal aortic aneurysm (AAA) repair, we conducted a prospective study to determine the differences in renal response between open (OR) and endovascular (EVAR) aneurysm repair. In a prospective, nonrandomized, single-center study, we evaluated 485 patients with AAAs undergoing OR or EVAR between January 2000 and December 2005. Only electively performed procedures were analyzed in detail. The OR group included 229 patients (males/females 203/26, median age 69.8 [range 43-90] years, aneurysm diameter in median 57 [26-95] mm), and the EVAR group integrated 144 patients (males/females 129/15, 73.1 [49-90] years [p=.001], 55 [33-100] mm). Renal function was assessed by determinating the preoperative serum creatinine (SCr) level and SCr clearance according to Cockcroft-Gault. Postoperatively, SCr level and SCr clearance were determined at defined intervals, reported as highest postoperative SCr level, SCr level at time of discharge, lowest postoperative SCr clearance, and SCr clearance at time of discharge. The parameters of height, weight, diabetes, smoking habit, serum cholesterol level, and hemoglobin were not different between the groups. Significantly different were the American Society of Anesthesiologists classification, the Society for Vascular Surgery Comorbidity Score, and the exposure to contrast dye. Moreover, significantly different were intraoperatively measured median blood loss (1,200 vs. 400 mL) and the median time of operation (164 vs. 135 min). Although, the preoperative SCr levels between the groups were not statistically different (OR group 1.0 [0.87-1.23] mg/dL [median, interquartile range], EVAR group 1.0 [0.9-1.3]; p > 0.05), the SCr clearance was (OR group 72.8 [58.2-98.8] mL/min, EVAR group 67.6 [51.3-85.1] mL/min; p = 0.007). In the postoperative period, SCr level did not change significantly in the OR group but did in the EVAR group to a level of 1.08 (0.9-1.36) mg/dL (p = 0.007). Similarly, SCr clearance decreased significantly in the EVAR group to a level of 66.7 (49.9-81.4) mL/min. These results were influenced by the stent graft design (deployment under the renal arteries vs. covering the renals with bared stents). Mortality was 3/229 in the OR group and 4/144 in the EVAR group. Acute renal impairment occurred in a subset of patients with AAAs with regard to the type of repair. EVAR showed a slight deterioration of renal function, but the evaluated tests are insensitive and without prognostic value concerning mortality or hospitalization. More sensitive markers of the differentiated renal functions (cystatin C for renal glomerular function, N-acetyl-ss-d-glucosamidase for proximal tubular function) should be evaluated in future studies.     

Objective scoring systems of medical risk: a clinical tool for selecting patients for open or endovascular abdominal aortic aneurysm repair

BACKGROUND: Objective scoring systems have been developed for risk stratification of open infrarenal aneurysm repair. To date, none have been applied for the selection of patients who would most benefit from either an open or an endovascular approach. This study assessed the utility of comorbidity-based objective scoring systems for defining subgroups of patients who might most benefit from open or endovascular aneurysm repair. METHODS: A retrospective database review was performed for the period January 1999 to December 2004 to identify patients who had undergone elective open aneurysm repair (open repair) or elective endovascular aneurysm repair (EVAR). Validation of the Glasgow Aneurysm Score (GAS), the Modified Leiden Score (M-LS), and the Modified Comorbidity Severity Score (M-CSS) was performed for perioperative mortality risk in the open repair group. GAS, M-LS, and M-CSS were then calculated for the EVAR group. Differences in open repair vs EVAR mortalities were evaluated. RESULTS: During the time period, 558 patients underwent open repair and 304 underwent EVAR. Overall mortality was 4.7% for open repair patients and 2.0% for EVAR. All three scoring systems were validated to our open repair data set (C statistic: GAS, 0.72; M-LS, 0.71; M-CSS, 0.74). A score was calculated for each system that separated patients into groups of either low or high risk of death for open repair. This score (cut point) was 76.5 for the GAS, 5.2 for the M-LS, and 8 for the M-CSS. Analysis of the EVAR population revealed that patients at low medical risk for open repair did not derive statistically significant mortality benefit with EVAR; however, patients at high medical risk for open repair derived significant benefit from EVAR (GAS>76.5 mortality: open repair, 7.8%; EVAR, 1.9% [P<.01]; M-LS mortality: open repair, 8.1%; EVAR, 2.5% [P<.01]; and M-CSS mortality: open repair, 10.3%; EVAR, 3.4% [P<.025]). Despite a very small number of deaths (n=6), receiver operator curve analysis identified M-LS and M-CSS as having some predictive ability for mortality risk with EVAR (C statistic: M-LS, 0.70; M-CSS, 0.69). CONCLUSION: Three validated objective scoring systems can be used to categorize patients into two groups of medical risk: one that has excellent outcome with open repair and derives no early mortality benefit from EVAR, and another that has significant mortality with open repair and derives important benefit with EVAR.     

Secondary intervention following endovascular repair of abdominal aortic aneurysm: a single centre experience.

AIMS: We aim from a review of our early and late experience of secondary intervention for technical failures, to examine and describe the impact of endovascular and open interventions. METHODS: 108 Abdominal Aortic Aneurysms (AAAs) repaired endoluminally between 1995-2001 were analysed. In our early experience, during 1995/96 home made pre-expanded polytetrafluoroethylene grafts fixed with Palmaz stents were used (n = 26). In our later experience, 1997/2001 Talent (n = 70) or Zenith endografts (n = 12) were used. All cases underwent spiral CT at 5 days and 6 monthly intervals post-op. Angiography was performed when further intervention was intended. All technical failures requiring intervention or not were studied. RESULTS: There were 28 (26%) technical failures identified of which 14 of 26 (54%) occurred in our early experience, and 14 of 86 (16%) occurred in our later experience (p < 0.05). Eleven in all required open conversion at the time of endovascular repair. Our study cohort were the remaining 17 cases requiring secondary intervention, seven were from our early experience and 10 from our later experience. There were 12 endoleaks, including two as a result of graft migration, two graft occlusions, two graft distortions and one graft infection. Overall 10 (66%) technical failures were treated by endoluminal repair and seven (34%) by open methods. However, in our later experience significantly more endoluminal techniques (80%) were used (p < 0.05). CONCLUSIONS: Technical failure rates were significantly higher in our earlier experience. Open repair, which was a feature of our early experience, has been avoided over the final 3 years. Instead, endoluminal techniques were used without further morbidity or mortality. Aneurysm rupture has not so far been experienced in this experience.     

Patient-reported quality of life after abdominal aortic aneurysm surgery: a prospective comparison of endovascular and open repair

PURPOSE: This study evaluated and compared changes over time in health-related quality of life reported by patients with infrarenal abdominal aortic aneurysm (AAA) undergoing elective endovascular (EVAR) and open aneurysm (OR) repair. METHODS: A prospective, nonrandomized cohort of 76 patients (62 men, 14 women; age range, 42 to 89 years) undergoing elective, infrarenal AAA repair (EVAR, n = 43; OR, n = 33) at two university teaching hospitals during a 15-month period were administered the Medical Outcomes Study Short-Form 36-item (SF-36) health survey preoperatively and then 1 week, 1 month, and 6 months postoperatively. Patient demographics, procedural details, postoperative follow-up data, and SF-36 scores were compared between groups. RESULTS: Both groups had total SF-36 scores that were significantly lower than preoperative scores at 1 week and 1 month after surgery but were not significantly different from the preoperative scores at 6 months (OR 66.2 +/- 21.1 to 72.3 +/- 19.8, P > .1; and EVAR 61.0 +/- 17.7 to 58.7 +/- 19.4, P > .1). Six-month total SF-36 scores were significantly higher in the OR group compared with the EVAR group (mean 72.3 +/- 19.8 OR vs 58.7 +/- 19.4 EVAR; P = .009). In the postoperative period, a significant drop occurred in mean scores in six of the eight domains of the SF-36 in the OR patients (physical function, PF; role physical, RP; bodily pain, BP; vitality, VT; social function, SF; role emotional, RE) and five domains for EVAR patients (PF, RP, BP, SF, RE). In two domains, RE and PF, scores returned to baseline values significantly sooner in EVAR patients than in OR patients (RE, EVAR 1 month vs OR 6 months; and PF, EVAR 1 month vs OR 6 months). In the VT domain, no significant postoperative drop occurred in the EVAR group, but in the OR group, mean scores were significantly lower at 1 week and 1 month compared with preoperative values. In the domains of general health and mental health, no significant drop occurred in SF-36 score postoperatively in either group. CONCLUSIONS: Patient reported health-related quality of life after infrarenal AAA repair is significantly impaired in the early postoperative period but returns to baseline by 6 months in patients treated with EVAR and OR. Patients having EVAR had significantly more rapid return to preoperative scores in selected domains of the SF-36. Even though EVAR is associated with shorter and less invasive perioperative hospital course and fewer postoperative complications, EVAR patients had lower quality of life scores 6 months after surgery than OR patients.     

Case report: endovascular repair of a thoracic aortic aneurysm (saccular type) with a stent-graft.

We describe the repair of a descending thoracic aortic aneurysm (saccular type, maximal size 85 mm) with an endovascular stent-graft in a 69-year-old man with chronic renal failure. The graft consisted of a self-expanding Z-stent covered with a woven polyester graft. An angiogram obtained intraoperatively showed complete thrombosis of the aneurysm. One month after the procedure, a contrast-enhanced computed tomographic (CT) scan showed thrombosis of the aneurysmal sac. A follow-up CT scan obtained 18 months after operation confirmed that the aneurysm had disappeared.