Endovascular Repair In The Treatment Of Complex Infrarenal Abdominal Aortic Aneurysm

Objective To investigate the technique and the effect in the treatment of the endovascular aortic repair(EVAR) of complex infrarenal abdominal aortic aneurysm(CIAAA).Methods The clinical data of 15 patients in Department of Vascular Surgery,Anhui Provincial Hospital of Anhui medical University with Complex Infrarenal Abdominal Aortic Aneurysm treated by EVAR was retrospectively analyzed. Analyzed the main points of operations and the clinical outcome.Results In all of the 15 patients Two had severe infrarenal aortic angulation (one of them had stinotic iliac artery). Fourteen patients had complex iliac artery, including the extremely tortuous,stenosis, occlusion or calcification The primary technical success rate was 100%. In-hospital mortality was 6.67%(1/15, died of heart failure 5 days after EVAR). The severe infrarenal aortic angulation in 2 cases were corrected by descending double guidewire technique.The stenosis of iliac artery were found in 7 patients,3 with seriously distorted iliac artery and 1 with severe infrarenal angulation. First coated guidewire was inserted through the stinosis, then the distorted and stinotic iliac arteries were corrected by descending double guidewire technique and buloon dilatation then the stent- grafts were released..Other stenotic iliac arteries were dilated by balloon only. One left iliac artery occlusion was recanalized by leading the guidewire through the occluded segment from contralateral iliac artery and buloon dilatation.Extremely distorted iliac artery were found in 10 cases. Of them,8 were corrected by superhard guide wire. There were no serious complications such as aneurysm rupture, vascular Penetration and iatrogenic dissection after the procedures.2 with extensive calcification And Distorted iliac artery were operated using descending double guide wire technique.All patients were followed up for 3-36months. During the follow-up period the mortality rate was 6.67%(1/15).There was two patients with endoleak were found after the surgery.One of the patients was diagnosed with spinal tuberculosis two years after the surgery and died of multiple organ failure. The other one disappeared during the follow-up period.Three tardive endoleaks were found (20%,3/15).One with type Ia and the other with type Ⅱ.and disappeared in six months.another 1a endoleak(because of the migration to the distal) was corrected by the cuff implantation. Reinterventional rate was 6.7%.Conclusion Nowadays most of us believe EVER is not a suitable means in the treatment of CIAAA But with the accumulation of experience, Technical progress and the development of stents, The Effect of EVER in the treatment of CIAAA is satisfactory. Technical success can be achieved. EVAR may be a feasible alternative for the treatment of complex infrarenal abdominal aortic aneurysm.