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The e-mémoires of the Académie Nationale de Chirurgie

Thoracoabdominal aortic aneurysm treatment with multilayer stent

BOUZIANE L | BOUAYED M | ZELMAT M | SEKKAL A | BENAROUSSI SA

Seance of wednesday 10 april 2013 (SEANCE COMMUNE AVEC LA SCV "SOCIETE de CHIRURGIE VASCULAIRE")

Abstract

Purpose. Thoracoabdominal aortic aneurysms (TAAA) are complex diseases and treatment difficult as they are intended for frail patientsThis is due to the difficulty of surgical treatment and the severity of the complications which causes endovascular treatment to grow. Can Multilayer stents represent a solution for this type of aneurysm?Materials and Methods. From March 2012, we carry out a prospective study mono centric. 31 patients were treated with 13 multilayer stents for AATA, classified in 2 cases Crawford type I, type II in 3 cases, type III in 5 cases and type IV in 3 cases. The series consists of 9 men and 4 women with an average age of 68 years (45 years - 81 years old). The average diameter of the aneurysm was 71mm (51-110mm). The procedure was performed under local anesthesia in 8 cases, local anesthesia in 1 case and 4 cases in general.Results. The initial technical success was 100%. There was no paraplegia, no stroke and no mesenteric ischemia. 3 access complications were treated surgically with success. 2 patients had renal failure; one of them was dialyzed (7.4%).The 30-day mortality unrelated to the aneurysm was 7.4%. (a case of massive myocardial infarction after the procedure) and in relation to the aneurysm 0%. A mean follow-up of 6 months (3 to 11 months) mortality unrelated to the aneurysm was 7.4% (1 death) and in relation to the aneurysm 0%.Thrombosis of the aneurysm sac was complete in 33.33% (4/12) cases. It decreased in diameter for 33.33% of cases (4/12) and keeps the same diameter in all other cases. Visceral arteries remained patent in 100% of cases.Conclusion. Multilayer stents can be a solution for AATA, especially in patients at high surgical risk or unfit for covered stent. The results appear encouraging.