Endovascular abdominal aortic aneurysm repair in patients with Marfan syndrome
| Autor: | Laurie Mondry, Allan M. Conway, Gautam M. Anand, Khalil Qato, Gary Giangola, Alfio Carroccio |
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| Rok vydání: | 2019 |
| Předmět: |
Marfan syndrome
Male medicine.medical_specialty Time Factors Endoleak medicine.medical_treatment 030204 cardiovascular system & hematology Endovascular aneurysm repair Marfan Syndrome 03 medical and health sciences Aortic aneurysm Blood Vessel Prosthesis Implantation 0302 clinical medicine Aneurysm Risk Factors medicine Humans Radiology Nuclear Medicine and imaging In patient Hospital Mortality Registries Aged Retrospective Studies business.industry Endovascular Procedures Retrospective cohort study General Medicine Middle Aged medicine.disease Abdominal aortic aneurysm Surgery Treatment Outcome Female Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Abdominal surgery Aortic Aneurysm Abdominal |
| Zdroj: | Vascular. 28(1) |
| ISSN: | 1708-539X |
| Popis: | Objectives Marfan syndrome patients are at risk for aortic degeneration. Repair is traditionally performed with open surgery as this is deemed more durable. Endovascular aneurysm repair remains controversial. We report on the outcomes of Marfan syndrome patients with abdominal aortic aneurysms undergoing endovascular aneurysm repair. Methods The Vascular Quality Initiative registry identified 35,889 patients, including 29 with Marfan syndrome, treated with endovascular aneurysm repair from January 2003 to December 2017. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results Median age was 70.0 years (IQR, 57.0–75.0), and 22 (75.9%) were male. Median aneurysm diameter was 5.3 cm (IQR, 4.9–6.3 cm), with an aortic neck length and diameter of 2.0 cm (IQR, 1.6–2.8 cm) and 2.5 cm (IQR, 2.2–2.8 cm), respectively. Twenty-one (72.4%) patients were asymptomatic, seven (24.1%) symptomatic, and one (3.4%) presented with rupture. Ten (34.5%) patients had prior aortic surgery. Six (20.7%) were unfit for open surgical repair. Length of stay was 2.0 days (IQR, 1.0–3.0 days). Percutaneous femoral access was performed in 15 (51.7%) patients with no complications. A type IA endoleak was present in one (3.4%), type IB in one (3.4%), and type II endoleak in two (6.9%) patients. There were no postoperative pulmonary, cardiac, or neurological complications. In-hospital mortality occurred in one (3.4%) patient who presented with a rupture and had been deemed unfit for open repair. A conversion to open repair was required. The patient expired on post-operative day 0. Early clinical success was achieved in 26 (89.7%) patients. Follow-up was available for 15 (51.7%) patients at a median time of 766 days (IQR, 653–937). There were no reinterventions or mortalities. Change in sac diameter was −0.6 cm (IQR, −1.1 to −0.2 cm), with no type I or III endoleaks. Discussion Endovascular aneurysm repair for patients with Marfan syndrome is feasible, and can be performed safely. Mid-term outcomes suggest this technique is durable. More robust long-term follow-up is needed. |
| Databáze: | OpenAIRE |
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