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Endovascular surgery for failed open aortic aneurysm repair
Ludwig K von Segesser1, Bettina Marty, Piergiorgio Tozzi
1Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. ludwig.von-segesser@chuv.hospvd.ch
Summary
Endovascular surgery effectively repairs aortic lesions after open repair. Intravascular ultrasound (IVUS) aids in identifying previous grafts, but long-term follow-up is crucial.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Aortic Disease Management
Background:
- Open surgical repair of aortic aneurysms can lead to late complications.
- Recurring aortic lesions after open repair present a significant clinical challenge.
Purpose of the Study:
- To evaluate the utility of endovascular surgery for treating aortic lesions that arise late after previous open aortic repair.
- To assess the safety and efficacy of endovascular techniques in this specific patient cohort.
Main Methods:
- Retrospective analysis of 286 descending thoracic and/or abdominal aortic aneurysms from 2000-2002.
- 13 patients underwent endovascular repair for recurrent lesions after failed open repair.
- Techniques included intravascular ultrasound (IVUS) guidance and controlled hypotension.
Main Results:
- No hospital deaths or neurological complications (paraparesis/paraplegia) were observed.
- An endoleak type I occurred in 2 patients (15%), with one requiring reintervention.
- One patient with a minor endoleak is scheduled for a 6-month follow-up.
Conclusions:
- Endovascular surgery offers an effective solution for recurrent aortic lesions post-open repair.
- Intravascular ultrasound (IVUS) is valuable for intraprocedural identification of prior surgical implants.
- Long-term surveillance is essential following endovascular repair of aortic lesions.