The current position of nonresective treatment for abdominal aortic aneurysm

This is a review of our 5 1/2-year experience with the treatment of infrarenal abdominal aortic aneurysms by thrombosis induced by outflow obstruction while adequate lower limb perfusion is simultaneously ensured by axillofemoral bypass. Sixty high-risk patients who were considered to be unsuitable for direct aortic replacement have been so treated. Preoperative angiographic investigation of the pelvic and visceral vessels is mandatory. Thrombosis of the aneurysm occurred in 42 patients within 72 hours after surgical interruption of the iliac outflow, while in the remainder, persistent patency was dealt with by radiologic deposition of thrombotic material in the remaining outflow arteries. Contrary to our previous report, an augmented computerized tomographic scan has proved to be more accurate than radionuclide flow studies for the determination of complete aneurysmal thrombosis. There were four deaths within 40 days (7%), and the remaining patients were followed for 6 to 48 months. There were three fatal ruptures, all as the result of inaccurate indication of thrombosis by radionuclide flow scan. The rate of survival by life table analysis was 55% at 24 months. There has been no evidence of proximal extension of the infrarenal thrombosis to visceral vessels. This experience suggests that this technique offers a reasonable alternative to the treatment of abdominal aortic aneurysms when the indication is compelling and the risk of direct graft replacement is excessive.