Endoluminal repair of abdominal aortic aneurysm: the Middlemore Hospital experience

With endoluminal stent graft (ESG) repair of abdominal aortic aneurysms (AAA) becoming more common, the morphological boundaries are constantly being pushed in deciding which patients to offer this mode of surgical management. In our tertiary hospital we have a relatively strict morphological selection as well as a multidisciplinary team that provides a good platform for performing endoluminal AAA repair.

A retrospective audit of patients undergoing elective endoluminal AAA repair at Middlemore Hospital (Otahuhu, Auckland, New Zealand) between 1999 and 2005 was performed; 40 patients were identified during this period and all records were reviewed. Prior to surgery, all patients had CT aortography with 3D-reconstruction, and each case was discussed at a multidisciplinary team meeting (vascular surgeons and interventional radiologists present). Patients less than 65 years of age were excluded from this endoluminal assessment. A strict morphological selection criteria was applied and adhered to.

Forty patients underwent elective endoluminal AAA repair between 1999 and 2005--5:1 male:female ratio and mean age 73.4 years. Fifty percent of patients had a history of ischaemic heart disease, 48% had known hypertension, 33% had known pulmonary disease, 12% had known diabetes mellitus, while a previous stroke, chronic renal failure, and current smokers respectively accounted for 18%. The American Society of Anaesthesiology (ASA) classification was used to assess patient fitness for surgery. Eighty percent of patients in this study had an ASA of III, 15% had an ASA of II, and the remaining patients had an ASA of IV. These figures are similar to Australian audit data (audit undertaken by ASERNIP-S). Morphology AAA showed mean diameter AAA of 5.2 cm (4.3?6.7 cm). Most AAA were fusiform (fusiform 90% vs saccular 10%). All grafts were of Zenith Cook type bifurcated grafts. There were 2 endoleaks (5%)--type II endoleaks that were sealed with endovascular therapy; 2 patients returned to theatre for embolic complications with good postoperative result; and 1 patient died due to myocardial infarction (MI) postprocedure (mortality 2.5%). Primary technical success was 95% and secondary technical success 100%. There were no conversions to open surgery and no procedural-related deaths.

This audit from Middlemore Hospital shows good results can be achieved using strict morphological selection criteria and a multidisciplinary approach to treatment for ESG of AAA.