ENDOVASCULER AND SURGERY FOR HYBRID APPROACH IN AORTIC ANEURYSM

Background: Endovascular stent graft (EVSG) repair has been more commonly used in recent years. During EVSG procedure, perioperative difficulties might be encountered as introduction of carrying system, opening of the graft, withdrawal of the graft. Thus, it might be necessary to combine EVAR and open surgery. It"s important to be ready for the additional and/or seconder surgery to solve peroperative problems encountered during EVAR procedure. It is aimed to evaluate the cases in which EVAR and open surgery performed in a multidisciplinary approach were combined in this study.

Material and Method: Cases in which EVAR and open surgery were combined from December 2004 to May 2007 have been evaluated prospectively.

Results: Endovascular-surgery combined approach was performed in 14 cases (20 %) among a total of 71 cases in which EVAR were performed. Problems in introduction of carrying system were observed in 6 cases. In 2 of them, PTA was performed because of the atherosclerotic plaque. In 3 of them, the level of arteriotomi was carried forward because of the accompanying iliac artery disease. In one of them, stent was used because of the tortiose-elongated iliac artery. Problem in opening of the graft was observed in 3 cases. In 2 of them, endoleak was detected and baloon was used. In one of them undesired distal placement was seen and aortic extender was used. In 7 cases problems in vascular structures were encountered. In 6 of them thrombosis of the graft was seen and femoro-femoral bypass was performed. In one of them rupture of the iliac artery was seen and graft was interposed.

Conclusion: In our study, perioperative problems were encountered in approximately 20 % of the cases treated with EVAR, which were solved by combined surgery-invasive radiological approaches. Technical background and team work should be ready for these problems which might be encountered and the success in EVAR is increased by this multidisciplinary approach. (Turkish J Vasc Sur 2007;16(3):31-36).