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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016
AFRICA
13
as EVAR-related morbidity, and death of the patient. Prior to
the operation, we measured maximum aneurysm diameters and
neck, as well as common femoral and iliac maximal diameters in
all CT axial slices.
In all patients, EVAR was performed via the main femoral
artery route. In 11 (20%) cases, local anaesthesia, and in 34 (60%)
cases, spinal and/or epidural anaesthesia were administered.
General anaesthesia was administered in 11 cases (20%). In five
of these cases the surgery began under local anaesthesia and then
switched to general anaesthesia.
The mean age of the patients in whom aneurysm repair was
performed with endovascular graft was 70.4 years (52–82); nine
patients were female and 47 were male. The following types of
grafts were implanted: in 31 cases Medtronic Endurant, in 19
Vascutek Anaconda, in three Trivascular Ovation, in two Gore
Excluder, and in one case Lombard Aorfix (Table 2).
Thirty (53.5%) patients were in group I and 26 (46.5%) were in
group II. The mean aneurysm diameter of patients in general was
calculated as 6.6 cm (4.5–10.5 cm). The mean aneurysm diameter
in group I was 5.8 cm (4.5–6.0 cm), and in group II it was 7.8 cm
(6.1–10.5 cm) (Table 2). The number of the patients on whom
urgent intervention was performed due to perforated aneurysm
was four (9.09%) and the success rate of treatment was 100%.
Statistical analysis
All data were expressed as mean and standard deviation using
the SPSS 15.0 statistical program. The correlations between
aneurysm diameter and mortality rate, and between neck length
and endoleak were compared using logistic regression, and the
other correlations were compared using the chi-squared test;
p
<
0.05 was accepted as significant.
Results
In four cases (7%), aorta–uni-iliac EVAR was performed and an
additional femorofemoral extra anatomical bypass was carried
out. In all other cases the EVAR graft was placed aorta–bi-iliac.
In one case, renal stent implantation was performed in the
same session. In one patient, surgery was performed after the
procedure to control bleeding due to iliac perforation.
In eleven cases (20%) an endoleak was detected during the
procedure. Type I endoleak was detected in eight cases, seven of
which were resolved after balloon application, and one was fixed
with an aortic extension graft. In two cases, type II endoleak was
detected; in one of these cases the causative vessel was occluded
and in the other the leak was accepted as insignificant and
followed up. Type IV endoleak was detected in one case and it
disappeared during follow up.
In two cases (4.54%) renal failure was observed in the early
period after EVAR. One of the patients returned to normal
after a six-month period of haemodialysis, whereas the other
continues life dependent on haemodialysis.
The mean duration of follow up of the patients included in
the study was 48 months for group I and 55 months for group II.
During the long-term follow up, two graft thromboses, one graft
migration, three endoleaks and one case of mesenteric ischaemia
were detected. Additional intervention was required in three
patients. In-hospital deaths were observed in four patients and
death occurred in a total of six patients (10.7%) (Table 3).
The mean EuroSCORE of all the patients was calculated as 4
(1–9), and the mean EuroSCORE of the patients who died was
7 (4–9). In the statistical analysis, which was performed using the
logistic regression method, no significant correlation was found
between group I and group II in terms of aneurysm diameter
and mortality rate. The increase in aneurysm diameter had no
effect on mortality rate (
p
>
0.05) (Table 4). The mortality rate of
the patients who had ruptured aneurysms was not different from
the patients with non-ruptured aneurysms (
p
=
0.4).
In 11 patients (19.6%), endoleaks were detected during the
procedure but no correlation was found between neck length and
endoleak development (
R
=
0.01,
p
=
0.83). In patients with an
observed endoleak during the procedure, even if treated, there
Table 1. Pre-operative characteristics of the patients
Aneurysm ≤ 6 cm
(group I)
Aneurysm
>
6 cm
(group II)
p
-value
Number (%)
30 (53.5)
(46.5)
>
0.05
Age (years)
68.5
72.1
>
0.05
Gender (M/F)
24/6
23/3
>
0.05
COPD,
n
(%)
16 (53)
18 (69)
0.02*
Smoking,
n
(%)
12 (40)
15 (58)
>
0.05
DM,
n
(%)
8 (26.6)
11 (20)
>
0.05
PAD,
n
(%)
2 (6.6)
6 (23)
0.001*
CABG,
n
(%)
3 (10)
5 (19)
0.02*
CAD,
n
(%)
10 (33)
8 (30.7)
>
0.05
COPD: chronic obstructive pulmonary disease, DM: diabetes melli-
tus, PAD: peripheral artery disease, CABG: coronary artery bypass
graft, CAD: coronary artery disease. *Statistically significant.
Table 3. Results during follow up
Group I Group II
p-
value
Mean duration of follow up (months) 48
55
>
0.05
Graft thrombosis (single leg)
2
–
>
0.05
Graft migration
–
1
>
0.05
Endoleak
1
2
>
0.05
Mesenteric ischaemia (
n
)
–
1
>
0.05
Additional intervention
2
1
>
0.05
Mortality,
n
(%)*
3 (10)
3 (11.5)
>
0.05
*Total mortality rate in hospital and during the follow up.
Table 2. Anatomical features of aneurysms
Aneurysm
≤ 6 cm
(group I)
Aneurysm
>
6 cm
(group II)
p
-value
Graft Endurant
14
17
>
0.05
Anaconda
12
7
0.01*
Ovation
3
–
0.001*
Excluder
1
1
>
0.05
Aorfix
–
1
>
0.05
Mean diameter (cm)
5.8
7.79
0.001*
Neck angle (°)
63
67
0.04*
Neck length (cm)
1.7
1.65
>
0.05
Right iliac angle (°)
87
95
>
0.05
Left iliac angle (°)
95
90
>
0.05
Endoleak,
n
(%)
4 (13.3)
7 (27)
0.02*
Femorofemoral cross-over
bypass,
n
(%)
1 (3.3)
3 (11.5)
0.02*
Ruptured aneurysm,
n
(%)
0 (0)
4 (9.09)
0.001*
*Statistically significant.