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M Lachat

Publications and source records attributed to M Lachat.

At least 19 recordsLinked to original sources
PubMed2004

[Subacute thoracic pain].

A 75-year old woman with essential hypertension presented two days after the onset of a sudden and strong thoracic pain. The pain did neither increase during breathing nor decrease after the ingestion of nitroglycerine, and could not be triggered by physical manipulation of the thoracic wall. Electrocardiogram showed a left bundle branch block, chest X-ray showed a widened upper mediastinum. Rupture/dissection of an aberrant right subclavian artery (a. lusoria) could be diagnosed by computed tomography. Successful implantation of an endovascular stent-graft was carried out. Evaluation of (sub)acute thoracic pain should include two-plane chest X-ray and, in case of a widened mediastinum, further investigation by computed tomography. In case of highly suspected rupture/dissection of an intrathoracic artery, a specific imaging procedure such as computed tomography is crucial.

Aged↗
PubMed2003

Aortic stent-grafting: successful introduction into the combined procedure for coronary artery bypass grafting and aortic aneurysm repair.

OBJECTIVES: Coronary artery bypass grafting (CABG) and combined stent-grafting (SG) were evaluated to reduce morbidity and mortality of patients with descending or infrarenal aortic aneurysm. METHODS: CABG and SG (thoracic n=6, infrarenal n=36) were performed during the same hospitalization in 42 patients (mean age of 73+/-14 years). In 29 patients (mean Euroscore: 9), SG was performed under local anesthesia 9+/-3 days after coronary surgery (simultaneous) and in 13 patients (mean Euroscore: 7) during the same anesthesia (synchronous). In the latter group, 11 out of 13 patients underwent off-pump CABG. All aneurysms were treated by implantation of commercially available self-expanding grafts. RESULTS: CABG was successful in all, but one patient with left internal mammary artery hypoperfusion syndrome, requiring an additional distal saphenous graft to the left anterior descending coronary artery. SG was uneventful in 98% (41/42 patients). Postoperative computerized tomography showed incomplete sealing in seven patients (17%), but only the two attachment endoleaks had to be treated by one proximal and one distal SG extension. Overall hospital stay for the synchronous repair was 12.5+/-6 days and that of the simultaneous group 17.5+/-7 days. Thirty-day mortality was 5% (2/42) as one patient of the simultaneous group experienced a lethal cerebral embolism during SG and one patient of the synchronous group developed an untreatable infection. In the follow-up of 4 years, there were two vascular reinterventions but no additional procedure-related morbidity or mortality. CONCLUSIONS: This experience shows that combined CABG and SG of thoracic or infrarenal aortic aneurysm is a safe and less-invasive alternative to the open graft repair, especially in the older patients or patients with severe comorbidities.

Aged↗
PubMed2003

Left ventricular assist device as bridge to heart transplantation--lessons learned with the MicroMed DeBakey axial blood flow pump.

OBJECTIVE: The MicroMed DeBakey left ventricular assist device (LVAD) axial blood flow pump was used as bridge to heart transplantation (HTx) in patients with terminal heart failure. The aim was to evaluate this novel mechanical circulatory support system in regard to overall outcome. METHODS: Prospective study in 15 HTx candidates (mean age 40+/-7 years) with terminal heart failure and maximal medical treatment due to ischemic cardiomyopathy (CMP, n=5), dilated CMP (n=3), restrictive CMP (n=2), unclassified CMP (n=1), metabolic CMP (n=1), valvular CMP (n=1) and congenital CMP (n=2). All patients were implanted with a MicroMed DeBakey LVAD. A rescue procedure was necessary in eight critical patients, while seven underwent elective LVAD implantation. Procedures were performed via median sternotomy, in normotherm femoro-femoral CPB (mean duration 59+/-1 min). Oral Marcoumar (INR 2.0-3.0) and Aspirin (100 mg daily) were started as soon as possible. Patients were discharged into a specialized rehabilitation clinic from which it was possible to release them home after a few weeks. RESULTS: Successful implantation and discharge from ICU (mean stay 10+/-7 days) was possible in 11 patients. Seven were transplanted (mean support 50.7 days) and one is awaiting HTx (support >310 days) in the comfort of his home (NYHA I). Survival was 100% among the transplanted patients. Of the seven elective implants, five, and of the eight rescue procedures three patients underwent successful HTx. Four patients died early, while three patients died late on pump support due to intracranial hemorrhage (n=2, 73 and 76 days) and chest infection (n=1, 124 days). All survivors were discharged from hospital, with significant decrease in NYHA class (mean 3.8-2.4 (n=11)). Treadmill testing showed increased exercise tolerance, from 35 to 71W (n=4). Plasma BNP values (mean 950-162 ng/l (n=4)) and pulmonary resistance (mean 316-194.5 dyne s/cm(5) (n=3)) decreased significantly during LVAD support. CONCLUSIONS: The MicroMed DeBakey LVAD is simple to implant; outpatient treatment is safe and efficient. Patients' condition and pulmonary resistances normalize within 6 weeks, making previously considered inoperable patients amenable for HTx. HTx can be performed in low-risk situation, allowing better donor-recipient matching and improving overall outcome.

Adolescent↗
PubMed2003

[Cardiac tamponade due to pericardial mesothelioma in an 11-year-old dog: diagnosis, medical and interventional treatments].

In a dog presenting with the clinical signs of exercise intolerance and ascites, cardiac tamponade due to suspected idiopathic pericarditis was diagnosed based on thoracic radiographs, electrocardiogram (EKG) and cardiac ultrasound. Pericardial effusion recurred soon after pericardiocenteses, prescription of colchizine and again after balloon pericardiotomy. After partial pericardectomy by thoracoscopy and after obtaining a histological diagnosis of mesothelioma adjuvant intracavitary chemotherapy using cisplatin was performed. Already one week later the dog developed marked dyspnea due to severe pleural effusion. The dog was maintained at acceptable life quality judged based on playfulness and appetite using repeated pleuro-centeses for an additional two months, when the dog was euthanized due to uncontrollable pleural effusion. Despite extensive treatments life span from initial presentation to euthanasia was only 5 months. Necropsy revealed extensive mesothelioma metastases covering the whole pleura, epicardium and remaining pericardium. Diagnostic and therapeutic aspects of (recurrent) pericardial effusion are discussed based on this case.

Animals↗
PubMed2002

[Septic endarteritis after angiography].

Infectious complications after angiography are rare. We treated a 72-year-old man who developed staphylococcus aureus endarteritis after angiography resulting in delayed rupture of the common iliac artery. Diagnostic problems, type of bacteria involved and therapeutic implications are discussed.

Aged↗
PubMed2002

Acute traumatic aortic rupture: early stent-graft repair.

OBJECTIVE: Prospective evaluation of early stent-graft repair of acute traumatic aortic rupture. METHODS: Twelve patients with acute traumatic aortic rupture of the descending aorta, out of a series of 337 endovascular aortic procedures, were treated by implantation of self-expanding stent-grafts. The procedures were performed within a mean post-injury time-period of 5+/-7 days (median: 1 day). The feasibility of stent-grafting was assessed by CT scanning and echography. Implantation was performed under local (n=6), or general anesthesia (n=6) if patients were already intubated (n=5) or required a common iliac artery access (n=1). RESULTS: The immediate technical success rate was 100%. There were no post-procedure complications in all but one patient, who died 12 h postoperatively (8% mortality). Complete sealing of the aortic rupture in the remaining 11 patients was confirmed by postoperative CT scans. There were no intervention-related morbidity or mortality during the mean follow-up of 17 months. One patient with peri-graft leakage was successfully repaired with an additional stent-graft 12 months postoperatively. CONCLUSION: Non-delayed or early stent-grafting in acute traumatic rupture of the descending aorta is feasible. This technique seems to be a valuable option, in particular when associated lesions may interfere with the surgical outcome. Immediate post-procedural CT scanning and/or echography should be performed, in order to rule out residual leakage.

Acute Disease↗
PubMed2002

Predictors of complications in acute type B aortic dissection.

OBJECTIVES: Medical treatment is generally advocated for patients with acute type B aortic dissection without complications. The objective of this retrospective analysis was to determine whether there are any initial findings that can help predict the long-term course of the disease. METHODS: Case records of the 130 patients treated for type B aortic dissection between 1988 and 1997 were reviewed; 41 (31%) were operated on in the acute phase (<14 days), 31 (24%) were operated on in the chronic phase and 58 (45%) were treated medically. RESULTS: Overall acute mortality was 10.8%; 22% for patients operated on in the early phase and 5.6% for medically treated patients. Age (P=0.002), persistent pain (P=0.01) and malperfusion (P=0.001) were significant independent predictors of the need for surgery. Paraplegia/para paresis (P=0.0001), leg ischaemia (P=0.003), pleural effusion (P=0.003), rupture (P=0.0001), shock (P=0.0001), age (P=0.003), cardiac failure (P=0.002) and aortic diameter >4.5 cm (P=0.002) were significant predictors of poor survival. Age and shock also emerged as independent risk factors. Patients without malperfusion (P=0.0001), pleural effusion (P=0.003), rupture (P=0.0001) and shock (P=0.0001) had a significantly better event-free survival (freedom from repeat surgery and death). The actuarial survival rate for high-risk patients (malperfusion, rupture, shock) was 62% at 1 year and 40% at 5 years; the corresponding values for low-risk patients were 94 and 84%, respectively. CONCLUSIONS: Rupture, shock and malperfusion are significant predictors of poor survival in patients with acute type B aortic dissection.

Adult↗
PubMed2002

Advanced training model for beating heart coronary artery surgery: the Zurich heart-trainer.

OBJECTIVE: Coronary artery surgery with beating heart technique is gaining increasing popularity. However, it is a challenging technique even for well-trained cardiac surgeons. Thus, a training model for beating heart surgery was developed to increase safety and accuracy of this procedure. METHODS: The model consists of differentially hardened polyurethane resembling mechanical properties of the human heart. The covering used in this model is a 1:1 replica of the human thoracic wall with optionally embedded skeletal structures. Sternotomy, lateral thoracotomy or trocar placement is possible to access the lungs, the pericardium and the heart with adjacent vessels. Disposable artificial coronaries variable in size, wall quality or wall thickness are embedded in the synthetic myocardium. Two-layer vessels, which can simulate dissection, are available. Bypass conduits utilize the same material. Coronaries/bypasses as well as part of the ascending aorta are water-tight and can be rinsed with saline. Lungs can be inflated. A purpose-built pump induces heart movement with adjustable or randomized stroke volume, heart rate and arrhythmia induction. RESULTS: The model was tested in a recent 'Wet-Lab' course attended by 30 surgeons. All conventional instruments and stabilizers with standard techniques can be used. Training with beating or non-beating heart was possible. Time needed for an anastomosis was similar to clinical experience. Each artificial tissue showed its individual nature-like qualities. Various degrees of difficulty can be selected, according to stroke volume, heart rate, arrhythmia, vessel size and vessel quality. The model can be quickly and easily set up and is fully reusable. CONCLUSIONS: The similarity to human tissue and the easy set-up make this completely artificial model an ideal teaching tool to increase the confidence of cardiac surgeons dealing with beating heart and minimally invasive surgery.

Cardiac Surgical Procedures↗
PubMed2001

Successful endovascular repair of a leaking abdominal aortic aneurysm under local anesthesia.

UNLABELLED: Local anesthesia is a safe and less invasive anesthetic management for the endovascular approach to elective aortic aneurysm. We have successfully extended the indication of local anesthesia to a high-risk patient with leaking aneurysm and stable hemodynamics. PATIENT AND METHODS: A 86 year old patient with renal insufficiency due to longstanding hypertension, coronary artery and chronic obstructive lung disease was transferred to our hospital with a leaking abdominal aortic aneurysm. Stable hemodynamics allowed to perform a fast CT scan, that confirmed the feasibility of endovascular repair. A bifurcated endograft (24 mm x 12 mm x 153 mm) was implanted under local anesthesia. RESULTS: The procedure was completed within 85 minutes without problems. The complete sealing of the aneurysm was confirmed by CT scan on the third postoperative day. Twenty months later, the patient is doing well and radiological control confirmed complete exclusion of the aneurysm. DISCUSSION: The endoluminal treatment is a minimally invasive technique. It's feasibility can be rapidly assessed by CT scan. The transfemoral implantation can be performed under local anesthesia provided that hemodynamics are stable. This anesthetic management seems to be particularly advantageous for leaking abdominal aortic aneurysm since it doesn't change the hemodynamic situation in contrast to general anesthesia. Hemodynamic instability, abdominal distension or tenderness may indicate intraperitoneal rupture and conversion to open graft repair should be performed without delay.

Aged↗
PubMed2001

To compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR).

OBJECTIVES: to compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR). METHODS: retrospective analysis of 91 consecutive patients (age 43 to 89 years) who underwent EVAR under local (LA, 63 patients), epidural (EDA, 8 patients) and general (GA, 20 patients) anaesthesia. RESULTS: EVAR was successfully achieved in all patients without mortality or neurological, cardiac and respiratory complications. Vasopressive support as well as median fluid balance were significantly lessened in the LA group compared to GA group (p<0.0002). Stay in the Intensive Care Unit was necessary in 17 (27%), four (50%) and 14 (70%) patients, respectively, and median hospital stay was 3, 4.5, and 5.5 days, with a statistically significant difference between LA and GA group (p<0.0005). CONCLUSION: LA is a safe anaesthetic method for the endovascular repair of infrarenal abdominal aneurysm, offering several advantages: simplicity, stable haemodynamics, and reduced consumption of ICU and hospital beds.

Adult↗
PubMed2000

HMG-CoA reductase inhibition improves endothelial cell function and inhibits smooth muscle cell proliferation in human saphenous veins.

OBJECTIVES: This study examined effects of 3-hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase inhibitor cerivastatin on human saphenous vein (SV), endothelial cells (EC) and smooth muscle cells (SMC). BACKGROUND: Venous bypass graft failure involves EC dysfunction and SMC proliferation. Substances that improve EC function and inhibit SMC proliferation would be of clinical relevance. METHODS: Both EC and SMC were isolated from SV. Endothelial nitric oxide synthase (eNOS) expression and nitric oxide (NO) production were analyzed by immunoblotting and porphyrinic microsensor. The SMC proliferation was assayed by 3H-thymidine incorporation. Protein kinases and cell cycle regulators were analyzed by immunoblotting. RESULTS: Cerivastatin (10(-9) to 10(-6) mol/liter) enhanced eNOS protein expression and NO release (about two-fold) in EC in response to Ca2+ ionophore (10(-6) mol/liter). This was fully abrogated by the HMG-CoA product mevanolate (2 x 10(-4) mol/liter). In SMC, platelet-derived growth factor (5 ng/ml) enhanced 3H-thymidine incorporation (298 +/- 23%, n = 4), activated cyclin-dependent kinase (Cdk2), phosphorylated Rb and down-regulated p27Kip1 (but not p21CiP1). Cerivastatin reduced the 3H-thymidine incorporation (164 +/- 11%, p < 0.01), inhibited Cdk2 activation and Rb phosphorylation, but did not prevent p27Kip1 down-regulation, nor p42mapk and p70S6K activation. Mevalonate abrogated the effects of cerivastatin on Cdk2 and Rb but only partially rescued the 3H-thymidine incorporation (from 164 +/- 11% to 211 +/- 13%, n = 4, p < 0.01). CONCLUSIONS: In humans, SVEC inhibition of HMG-CoA/mevalonate pathway contributes to the enhanced eNOS expression and NO release by cerivastatin, whereas in SMC, inhibition of this pathway only partially explains cerivastatin-induced cell growth arrest. Inhibition of mechanisms other than p42mapk and p70S6K or Cdk2 are also involved. These effects of cerivastatin could be important in treating venous bypass graft disease.

Cell Division↗
PubMed2000

Tissue endothelin-converting enzyme activity correlates with cardiovascular risk factors in coronary artery disease.

BACKGROUND: Endothelin-converting enzymes (ECEs) are the key enzymes in endothelin-1 (ET-1) generation. However, their pathophysiological role in patients with cardiovascular disease remains elusive. METHODS AND RESULTS: Vascular reactivity to big endothelin-1 (bigET-1; 10(-9) to 10(-7) mol/L) and ET-1 (10(-9) to 10(-7) mol/L) were examined in the internal mammary artery (IMA, n=33) and saphenous vein (SV, n=27) of patients with coronary artery disease with identified cardiovascular risk factors. Vascular ECE activity was determined by conversion of exogenously added bigET-1 to ET-1. Tissue contents of bigET-1 and ET-1 were measured by radioimmunoassay. In addition, the effects of LDL and oxidized LDL on ECE-1 protein levels were determined by Western blot analysis in human IMA endothelial cells. In the IMA, vascular ECE activity showed an inverse correlation with serum LDL levels (r=-0.76; P<0.01) and systolic and diastolic blood pressure and a positive correlation with fibrinogen (r=0.58; P<0.05). In the SV, fibrinogen was the only parameter to be correlated with vascular ECE activity. Vascular tissue content of bigET-1 was attenuated in the IMA of patients with hyperfibrinogenemia but increased in patients with elevated systolic blood pressure and increased serum LDL levels (P<0.05). Most interestingly, LDL and oxidized LDL downregulated ECE-1 protein levels in human IMA endothelial cells (P<0.05). CONCLUSIONS: These data demonstrate, for the first time, that vascular ECE activity is (1) inversely correlated with serum LDL levels and blood pressure and (2) positively associated with fibrinogen in human vascular tissue. Hence, ECE-1 activity may modulate cardiovascular risk in patients with coronary artery disease.

Aspartic Acid Endopeptidases↗
PubMed2000

[Proximal anastomoses of aortocoronary bypasses. Evaluation with ECG-triggered single-slice computerized tomography].

PURPOSE: Assessment of coronary artery bypass graft (CABG) patency with computed tomography methods has been demonstrated as an alternative to coronary angiography. The evaluation of the bypass anastomoses is still of limited success. Prospective ECG triggering of conventional CT scanners allows heart phase-triggered single-slice acquisition in the sub-second range. The goal of this study was to evaluate whether the use of ECG triggering can optimize the evaluation of proximal CABG anastomoses. MATERIALS AND METHODS: In ten patients after CABG surgery, ECG-triggered CT with thin (2 mm), contiguous slices was performed in the region of the proximal bypass anastomoses in the ascending aorta. The data evaluation was done on axial images and on reconstructed 2D and 3D data sets. RESULTS: The applied technique demonstrated good imaging quality, which allowed evaluation of the CABG anastomoses in all cases. Overall 18 CABG anastomoses could be visualized; 17 anastomoses could be assessed as normal, non-stenotic and patent. DISCUSSION: ECG-triggered thin-slice CT permits reliable assessment of proximal CABG anastomoses and expands the usage of CT in the evaluation of CABG.

Adult↗
PubMed2000

Reoperative surgery for degenerated aortic bioprostheses: predictors for emergency surgery and reoperative mortality.

OBJECTIVE: The long-term outcome of patients with aortic bioprosthetic valves could be improved by decreasing the reoperative mortality rate. METHODS: Predictors of emergency reoperation and reoperative mortality were identified retrospectively in 172 patients who had the first bioprosthetic aortic valve replacement between 1975 and 1988 (mean age 46+/-13 years) and were subjected to replacement of the degenerated bioprostheses between 1978 and 1997 (mean age 56+/-14 years). Emergency reoperation had to be performed in 31 patients (18%). RESULTS: The operative mortality was 5.2% (9/172), 22.6% for emergency (odds ratio 11.17; 95%-confidence limit 4.33-28.85) and 1.4% for elective replacement of the degenerated aortic bioprosthesis (P<0.0001; OR=20.3). Patients who died at reoperation had higher transvalvular gradients before the primary aortic valve replacement (P=0.007), received smaller bioprostheses at the first operation (P=0.03), had later recurrence of symptoms after the first aortic valve replacement (P=0.04), a higher pre-reoperative New York Heart Association (NYHA) class (P=0.02), and a higher incidence of coronary artery disease (P=0.001) and pulmonary artery hypertension (P=0.009). Endocarditis before the primary aortic valve replacement (P=0.004), postoperative pneumonia at the first operation (P=0.005), pulmonary hypertension (P=0.0004) acquired during the interval, later recurrence of symptoms (P=0.04) after the first operation, a lower ejection fraction at the time of reoperation (P=0.03) and acute onset of bioprosthetic regurgitation (P=0.00002) were predictors for emergency surgery. Higher transvalvular gradients at the primary aortic valve replacement (P=0. 006), coronary artery disease (P=0.003) acquired during the interval, the need for concomitant coronary artery revascularization (P=0. 001), sex (P=0.02) and size (P=0.05) and type of the bioprostheses used (P=0.007) were incremental predictors for reoperative mortality which were independent of emergency surgery. CONCLUSIONS: Elective replacement of failed aortic bioprostheses is safe. Patients undergoing emergency reoperation have a considerably higher mortality. They can be identified by a history of native aortic valve endocarditis, higher transvalvular gradients at primary aortic valve replacement, smaller bioprostheses, and pulmonary hypertension or coronary artery disease acquired during the interval. A failing bioprosthesis must be replaced at its first sign of dysfunction.

Aortic Valve↗
PubMed2000

Affinity pump system: a new peristaltic blood pump for cardiopulmonary bypass.

An in vitro study has been carried out to assess the pump performance of a new peristaltic, extracorporeal displacement pump (Affinity) for cardiopulmonary bypass. The pump system consists of a pump rotor (0-110 rpm), a pump chamber, a venous reservoir with a 5/8" connecting tube and the Affinity console. The polyurethane chamber is connected to the venous reservoir by a 5/8" tube and fills passively due to the hydrostatic pressure exhibited by the fluid height in the venous reservoir. The implementation of an occlusive segment in the pump chamber, which collapses in low filling states, should prevent significant negative pressures. An in vitro circuit was filled with bovine blood (37 degrees C, hematocrit 35%) and the pump flow was measured by an ultrasonic transit time flow probe with respect to pre-load, diameter and length of attached tubing in the venous line, pump speed (rpm) and size of the connecting tube (3/8" and 5/8"). At 108 rpm and a preload equal to 10 mmHg, the flow was 8.6 +/- 0.42 l/min for an afterload of 80 mmHg. The reduction of the inlet connector to 3/8" diminished the pump flow significantly to 5.2 +/- 0.31 l/min (p < 0.0001). The pump flow decreased linearly with respect to the length of the attached tube in the venous line and for a 2 m long 5/8" silicon tube, the rpm-optimized flow was still 6.0 +/- 0.28 l/min at a preload of 10 mmHg. In case of low filling state or too high rpm, the occlusive segment collapsed and no cavitation bubbles could be detected. Our in vitro measurements yield a nomogram for rpm-optimized blood flow with respect to the pre-load in the venous reservoir. The delivered 5/8"connecting tube facilitates optimum filling of the pump chamber for high blood flow, but limits the use of venous reservoirs to Affinity products. The pump yields a high blood flow even when long tubing in the venous line is used. This makes the pump a candidate for a ventricular assist device. In hypovolemia or high rpm, the occlusive segment collapses and no negative pressure is generated at the inflow site of the pump chamber.

Animals↗
PubMed1999

Operative results of "repair" of ventricular septal rupture after acute myocardial infraction.

Fifty-four consecutive patients with postinfarction ventricular septal defect were reviewed. The rupture was closed with a patch and the left ventricle remodeled in all patients. Coronary artery bypass surgery was performed in 28 patients (52%). Fourteen patients (26%) died after operation and 19 during follow-up (mean 42 months). Cumulative survival (including operative deaths) was 78%, 65%, and 40% at 1, 5, and 10 years, respectively. A short interval between septal rupture and operation was a risk factor for early mortality (p = 0.03). Treated associated coronary artery disease had no effect. A residual septal shunt, detected in 10 patients (18%), warranted reoperation in 7 and contributed to 2 early and 1 late death. The location and morphology of the septal rupture were not associated with increased risk of residual shunt. Thus, patch closure of the ventricular septal rupture, remodeling of the left ventricle to improve stroke volume and reduce wall stress, and selective myocardial revascularization provided acceptable results.

Aged↗
PubMed1999

[Endovascular treatment of the abdominal aortic aneurysm: assessment, implantation technique, after-care and results].

BACKGROUND: Endovascular treatment of abdominal aortic aneurysm (AAA) is a new minimally invasive alternative to surgical repair. Patient selection, perioperative management, the procedure itself and postoperative follow-up are new aspects. PATIENTS: From June 1997 to June 1998, 37/70 patients (53%) with AAA were treated by the endovascular method. There were 35 males and two females, mean age 74 +/- 7 years, with a mean ASA class of 3.5 +/- 0.5. Graft repair was performed in 33 patients, due to inappropriate aortic anatomy for the endovascular technique in 24 and leaking aneurysm in 9. METHODS: Feasibility is based upon computed tomography and angiography. The procedure was performed in the operating room, under general, regional and local anaesthesia in 14, 3 and 20 patients, respectively. 36 bifurcated and one tube endoprosthesis were implanted. An open access on one femoral or iliac artery and, in case of bifurcated prosthesis, usually a percutaneous access (10 Fr) on the other side were performed. Positioning and delivery were monitored under fluoroscopy. RESULTS: All the AAA could be sealed by the endovascular technique. In one patient, an iliac limb was removed surgically because of proximal misplacement, but the procedure was completed by the endovascular technique. Mean operation time was 140 +/- 67 minutes. ICU stay was 1.4 +/- 1.6 days and patients were discharged after 6.5 +/- 3.5 days. Postoperative radiological follow-up showed totally sealed aneurysms in 34/37 patients (91%). In 3 patients a residual perfusion originating from a lumbar artery was observed. In 7/14 patients with AAA diameter > 6 cm and without residual leakage on the control CT scan, aneurysm pulsation remained after endovascular treatment. There was no early or late death after endovascular repair. During the follow-up period of 4 +/- 3 months patients are doing well. One patient needed balloon dilatation of an iliac limb. CONCLUSIONS: Endovascular treatment of AAA is a minimally invasive technique with short recovery time. This technique seems to be particularly advantageous in elderly or severely ill patients. Long-term controls are mandatory to identify potential complications, particularly when residual perfusion or aneurysm pulsation persists.

Aged↗