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Complementary surgical/interventional techniques for nonresective management of "inoperable" aneurysms: a second look
G J Todd1, J J DeRose, E C Martin
1Division of Vascular Surgery, Columbia University College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Annals of Vascular Surgery
|May 20, 1998
Summary
Combined surgical and interventional techniques offer a life-saving option for aortic aneurysms when other methods fail. Ensuring complete aneurysm thrombosis is crucial for long-term success and preventing rupture.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Aneurysm Repair
Background:
- Induced thrombosis (nonresective) therapy for aortic aneurysms faced skepticism due to early anecdotal reports.
- Conventional and endovascular aneurysm repair have established survival rates but are not suitable for all patients.
- Some patients are deemed 'inoperable' for standard surgical interventions due to conditions like retroperitoneal fibrosis.
Purpose of the Study:
- To re-evaluate the efficacy and safety of combined surgical/interventional 'nonresective' aneurysm repair.
- To assess the outcomes of this technique in patients unsuitable for conventional or endovascular repair.
- To identify critical factors for successful long-term aneurysm thrombosis and repair adequacy.
Main Methods:
- Review of 10 patients undergoing combined surgical/interventional nonresective aneurysm repair between 1990 and the study period.
- Procedures included distal arterial ligation, coil/wire embolization, and extraanatomic bypass.
- Follow-up included imaging (MRI, CT) and contrast angiography to confirm complete aneurysm thrombosis.
Main Results:
- All 10 patients (100% survival) survived the combined surgical/interventional repair.
- The treated aneurysms included aortoiliac, common iliac, internal iliac, and a subclavian artery pseudoaneurysm.
- At a mean follow-up of 40.3 months, 80% of patients were alive, with no aneurysm ruptures reported, though one case required re-intervention due to incomplete thrombosis.
Conclusions:
- Combined surgical/interventional techniques can be life-saving for selected patients with complex or inoperable aneurysms.
- Complete aneurysm thrombosis is essential for the long-term success of nonresective therapy.
- Contrast angiography and close follow-up are vital to confirm thrombosis and detect potential complications like incomplete thrombosis.