doiSerbia

Morbidity and mortality in the early postoperative course following elective reconstruction of abdominal aorta aneurysm using endovascular and open surgical techniques

Marjanović Ivan (Klinika za vaskularnu hirurgiju, Vojnomedicinska akademija, Beograd)
Jevtić Miodrag (Uprava, Vojnomedicinska akademija, Beograd)
Mišović Sidor (Klinika za vaskularnu hirurgiju, Vojnomedicinska akademija, Beograd)
Čolić Miodrag (Institut za medicinska istraživanja, Vojnomedicinska akademija, Beograd)
Zoranović Uroš (Klinika za vaskularnu hirurgiju, Vojnomedicinska akademija, Beograd)
Šarac Momir (Klinika za vaskularnu hirurgiju, Vojnomedicinska akademija, Beograd)
Rusović Siniša (Institut za radiologiju, Vojnomedicinska akademija, Beograd)
Jovanović Milan (Klinika za abdominalnu i endokrinu hirurgiju, Vojnomedicinska akademija, Beograd)

Backgroud/Aim. Surgical treatment is the only method of abdominal aorta aneurysm (AAA) treatment. According to data of the available literature, elective open, ie conservative, reconstruction (OR) is followed by 3%-5% mortality, as well as by numerous comorbide conditions inside the early postoperative course (the first 30 days after the surgery) that occur in 20%-30% of the operated on. The aim of the study was to present preliminar results of a comparative clinical retrospective study of early postoperative morbidity and mortality in AAA reconstruction using endovascular (EVAR) and open surgical techniques. Method. This comparative clinical retrospective study included 59 patients, electively operated on for AAA within the period January 2008 - March 2009, divided into two groups. The group I counted 29 (49%) of the patients who had been submitted to EVAR by the use of Excluder stent. The group II consisted of 30 (51%) of the patients operated on using OR. All of the patients were males, 50-87 years old (mean 67.6 year in the group I, and 54-86 years (mean 68.3 years) in the group II. All tha patients had AAA larger than 50 mm, in the group I 50-105 mm (mean 68 mm), and in the group II 50-84 mm (mean 65 mm). Preoperative comorbide conditions of any patients were similar (coronary disease, obstructive lung disease, chronical renal insufficiency). Patients operated on as emergency cases due to rupture or due to symptomatic aneurysm (threthening rupture) were excluded. The analysed parameters were the duration of surgical operation, intraoperative and operative blood substitution, postoperative morbidity, the duration of postoperative hospitalization, and hospital mortality. Results. The obtained results showed a statistically significantly shorter time taken by EVAR surgery (average 95 min, ranging 70-180 min) as compared to OR surgery (average 167 min, ranging 90-300 min). They also showed statistically significantly less blood loss in the patients operated on by the use of EVAR surgery (average blood compensation 130 mL, ranging 0-1050 mL) as compared to OR surgery (average blood compensation 570 mL, ranging 0-2.000 mL). Also, general complications as wound infection, no restoration of intestines peristalsis, febrility, proteinic and electolytic disbalance, lung and heart decompensation were statistically significantly less following EVAR than OR surgery. Postoperative hospitalization was also statistically significantly shorter after EVAR than after OR surgery (average 4.2 days, ranging 3-7 days; 10.6 days, ranging 8-35 days, respectively). Finally, within this 13- month study there was no mortality following EVAR surgery, while two patients died after OR surgery. Conclusion. In the patients with elective AAA reconstruction endovascular reconstruction is shown to be far more safer and minimally invasive procedure than open conventional aorta reconstruction.

Keywords: aortic aneurism, vascular surgical procedures, endoscopy, postoperative period, postoperative complications, comorbidity, mortality