[Elective stent treatment of abdominal aortic aneurysm]

First described in 1991, endovascular treatment is a simplified method for abdominal aortic aneurysm repair (EVAR). The enthusiasm created by few complications and early mobilisation was replaced by scepticism because of the high frequency of secondary complications such as endoleak, stenosis, graft migration, aneurysm enlargement and late rupture. Though the method still is considered experimental, thousands of grafts are inserted every year.

From 1998, 53 patients underwent EVAR electively at our institution, 17 of whom were for medical reasons considered inoperable in open surgery. They were followed up with CT scans, which together with angiograms were evaluated retrospectively. Co-morbidity and complications were registered. Follow up was at 26 (4-50) months for 49 patients.

Two patients died. There were two other complications in addition to two superficial wound infections. There were no surgical conversions. 18 patients had 25 secondary interventions. Cumulative intervention rate was 25% after 12 months, 28% after 24 months and 53% after 36 months. Four stenoses were seen the first 6 months. 19 patients had an endoleak (1 had type I after 24 months, 6 had type II endoleak, 5 had type III endoleak of which two appeared after 3 years). Graft migration was observed in 9 patients (5 at 3 years control). Two ruptures were corrected with endovascular technique. Survival and interventions were equal among inoperable and operable patients.

Few early complications are overshadowed by the frequent and unpredictable late complications after EVAR; patients have to be followed up for years. For patients unfit for open surgery this is, however, an optional treatment if intervention is otherwise indicated.