Endovascular abdominal aortic aneurysm treatment with the excluder stent graft in the interventional cardiology suite in moderate to high-risk patients

Background: Endovascular abdominal aortic aneurysm (AAA) exclusion with stent graft implantation has been shown to be feasible and safe in selected patients (pts). Current data suggest that the pts most likely to benefit from this procedure are those at increased risk for surgical repair. We report our initial experience of AAA endovascular treatment using the Excluder stent graft in the interventional cardiology suite in a moderate- to high-risk pt group. Methods: The study included 32 pts (100% men; mean age 71.1   10.5 years, range 54–92) who underwent Excluder stent graft implantation (Gore & Associates, Sunnyvale, CA) to treat infrarenal AAA. Of these, 27 (84%) pts presented with a II–III American Society of Anesthesiologists risk score due to age and pulmonary or cardiac comorbidity and were considered at moderate to high risk. Tortuous iliac anatomy was present in 10 pts (31%). The first 7 procedures were performed with epidural anesthesia, and the next 25 interventions with local anesthesia only. Access for the 18-Fr bifurcated main segment was via surgical exposure of the femoral artery, whereas that for the 12-Fr iliac limb device was obtained percutaneously. A clinical and imaging (contrast computed tomography [CT] scan, delayed images and 3-dimensional reconstruction) follow-up protocol was performed in all pts. Results: The mean interventional time was 128 +/- 24 minutes with a total fluoro time of 15 +/- 5.5 minutes. The procedural success was 100%. Final angiography showed effective AAA exclusion in all pts. No acute conversion to surgical repair was needed for any pt. The only vascular complication was a femoral artery pseudoaneurysm at the percutaneous access site requiring surgical repair. No in-hospital or 1-month procedure-related mortality was observed. One pt developed acute renal failure but recovered completely in few days. Currently, 1- and 3-month clinical and imaging follow-up is available for 31 and 30 pts, respectively; 6-month follow-up is available for 25 pts and 1-year follow-up for 22 pts. Type II endoleaks were detected at 1-month CT scan in 3 (9%) pts. One endoleak disappeared at 3-month follow-up. Persistent type II endoleaks were observed in the remaining 2 (6%) pts at 6-month and 1-year follow-up. In one of them, a secondary procedure for endoleak repair was needed because of aneurysmal sack enlargement. Overall, the baseline mean aneurysm diameter (49.7 +/- 8 mm, range 30–68 mm) decreased to 45.5 +/- 9.5 mm and 43 +/- 9.7 mm (p = 0.03) at 6- and 12-month CT scan follow-up, respectively. Conclusions: Endovascular exclusion of infrarenal AAA with the Excluder stent graft can be safely and successfully performed in an interventional cardiology suite in moderate- to high-risk patients. Longer follow-up will determine the long-term outcome of AAA endovascular treatment with this device.