Endovascular stent graft repair of aorto-iliac pseudoaneurysms - Hospital Kuala Lumpur experience
- Author:
Nan Chuang Khang
;
Zainal Ariffin bin Azizi
- Publication Type:Journal Article
- Keywords:
Stent graft;
mycotic aneurysm;
pseudoaneurysm;
aorto-iliac disease
- MeSH:
Aneurysm, False
- From:
The Medical Journal of Malaysia
2016;71(1):17-22
- CountryMalaysia
- Language:English
-
Abstract:
Background: This is a single institutional review of aortoiliac
pseudoaneurysm of various aetiologies managed with
endovascular stent graft repair.
Methods: From 2009 to 2014, 16 patients had endovascular
stent graft inserted for pseudoaneurysm of the thoracic
aorta, abdominal aorta and iliac arteries in Hospital Kuala
Lumpur. Co-morbidity, causative agents, in-hospital
mortality, complications and outcomes were examined.
Results: The average age was 59.1 years (range 36-77).
Comorbidities include hypertension, diabetes mellitus,
tuberculosis, prior infection and previous open aneurysmal
repair. All patients had raised WBC (>10.0x109 /L), ESR or Creactive
protein on admission while 50% of patients had
fever. Blood cultures were positive in 4 patients. All patients
were given antibiotics. Only one in-hospital mortality was
noted at day-47 post-procedure. Two patients died of aortoenteric
fistula at district hospital eight and 16 months later.
One patient died of chronic graft infection two years later.
One died of unrelated cause. One patient developed type IB
endoleak from internal iliac artery two years later and
surgical ligation was performed. The average follow up was
15.8 months.
Conclusion: Endovascular stent graft repair for
pseudoaneurysm is a viable option compared to open
surgery. It is less invasive, has lower operative morbidity
and fair outcomes. However, some cases may be due to
inflammatory aortitis instead of infective pseudoaneurysm,
given the frequent culture-negative results. In order to
obtain high yield of bacteria culture for infected
pseudoaneurysm, open repair with tissue culture is still the
main mode of treatment especially for patients with low comorbidity.
- Full text:P020160509461600480248.pdf
