Endovascular repair of acute AAAs under local anesthesia with bifurcated endografts: a feasibility study

PURPOSE

To evaluate endovascular repair of abdominal aortic aneurysms (AAA) under local anesthesia in the acute setting.

METHODS

Between 1998 and 2001, 47 patients with an acute AAA were evaluated for endovascular repair after informed consent, provided they were in a stable, albeit hypotensive condition. The patients underwent urgent computed tomography to assess suitability for endovascular repair; 16 were eligible for stent-graft repair: 9 were frank ruptures and 7 were symptomatic aneurysms. Complications and outcome of endovascular repair were evaluated; mortality was compared to a contemporaneous surgical cohort.

RESULTS

Seven (23%) of 31 patients having a standard surgical procedure died in the study period compared to 1 (6%) of 16 patients undergoing endovascular repair (following conversion to surgery because of calcified access vessels). Twelve (75%) of the endovascular repairs were performed under local anesthesia; no complications with this mode of anesthesia were encountered. The median duration of the endovascular procedures was 110 minutes (range 75-240); median blood loss was 250 mL (range 100-2800 mL). Only 4 patients required blood transfusion, and only 8 patients required admission to the intensive care unit. There were 3 postoperative complications (1 ischemic colitis, 1 renal failure, 1 groin hematoma). During follow-up, 3 endograft patients received stent-graft extensions in uneventful procedures. Two patients died at 9 and 16 months from cardiac causes.

CONCLUSIONS

This study demonstrates the feasibility and possible advantages of endovascular repair under local anesthesia in selected acute AAA patients. Further studies are needed to prove the advantages over open repair.

Stent-graft repair of a recurrent popliteal arteriovenous fistula

PURPOSE

To describe the successful endovascular treatment of a popliteal arteriovenous fistula with a stent-graft.

CASE REPORT

A 54-year-old man was referred to our hospital with a distal popliteal arteriovenous fistula following an arthroscopic meniscectomy 6 years earlier. Three surgical attempts to close the fistula were undertaken, but the fistula recurred. He now presented with symptoms of progressive venous hypertension with claudication, swelling of the leg, and ulceration at the ankle. The fistula was closed with a stent-graft deployed percutaneously. At 18 months, the patient is doing well; duplex evaluation has documented the patency of the popliteal artery and the stent-graft.

CONCLUSIONS

Endovascular treatment of a popliteal arteriovenous fistula is an alternative to open surgical reconstruction. In this situation, after multiple failed surgical closures and in a leg with extensive venous hypertension, it may be the best treatment option.