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Simultaneous Operation vs Staged Treatment Using Endoluminal Stent Grafting

Alexander M. Prusa, MD; Klaus S. Wolff, MD; Marjana Sahal, MD; Peter Polterauer, MD; Johannes Lammer, MD; Georg Kretschmer, MD; Ihor Huk, MD; Harald Teufelsbauer, MD

Arch Surg. 2005;140:686-691.

Hypothesis  To investigate whether staged or synchronous treatment of infrarenal abdominal aortic aneurysms (AAAs) and concomitant diseases (CDs) requiring surgical repair plays a clinical role. We considered endovascular aneurysm repair (EVAR) in particular.

Design  Review of a prospectively gathered database.

Setting  Tertiary care university teaching hospital.

Patients  We reviewed a total of 946 patients receiving elective AAA exclusion from 1980 through 2002. We divided the period into 2 observation intervals: 1980-1994, when only open graft replacement was available (n = 331), and 1995-2002, with 615 patients (326 who had open graft replacement and 289 who had EVAR). With regard to the physical status, expressed by the score from the American Society of Anesthesiologists (Park Ridge, Ill), we recorded in-hospital mortality rates and checked possible differences.

Main Outcome Measures  Indications for therapy and mortality rates before and after the availability of EVAR.

Results  During the first interval, 14 simultaneous operations were carried out. During the second period, 19 patients received simultaneous operations while 49 underwent staged treatment using EVAR. The overall mortality rate was 3.7%. Irrespective of the American Society of Anesthesiologists classification, the mortality rate for patients who had EVAR was 0% in comparison with 13.6% for patients in American Society of Anesthesiologists class 3 or 4 after open graft replacement (P<.03).

Conclusions  The coincidence of a patient having both an AAA and a CD is rare but should not be neglected. Staged treatment of AAAs using EVAR followed by surgical therapy for CDs can be an effective causal therapy with an acceptable mortality rate provided that suitable aneurysm anatomy exists.

Author Affiliations: Departments of Vascular Surgery (Drs Prusa, Sahal, Polterauer, Kretschmer, Huk, and Teufelsbauer) and Angiography and Interventional Radiology (Dr Lammer), Medical University of Vienna; Department of Surgery, Austrian Armed Forces Hospital (Dr Wolff); and Ludwig Boltzmann Research Institute of Interdisciplinary Clinical Vascular Medicine (Drs Prusa, Sahal, Polterauer, Kretschmer, Huk, and Teufelsbauer) Vienna, Austria.

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