Search

Background and Aims: With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The long-term outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered. Materials and Methods: Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54–85) with AAA (average 57mm, range 40–90mm) were treated with a Vanguard® endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually. Results: The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6–120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery disease. There were ten late conversions to open surgical repair, including three emergency operations: two due to rupture and one to thrombosis. EVAR-related complications were encountered in 43 patients (90%): 12 primary endoleaks (all type II), 36 late endoleaks (16 type I, 2 type II and 18 type III), 22 migrations, 25 row separations, 20 thromboses, one endotension and 3 ruptures of the AAA. Secondary procedures were required in 39 patients (81%): 1 re-endografting by aortoiliac bifurcated graft and 3 with a uni-iliac graft; 33 limb graft repairs were performed and 19 infrarenal cuffs were placed. There were 4 late embolizations and 4 attempts, and 6 thrombolyses, four of which were successful. Further, 9 femoro-femoral crossover by-pass and 2 axillo-femoral by-pass operations and 2 amputations were carried out during the follow-up. Only one patient was alive without complications. Conclusions: The impact of long-term follow-up of patients treated with the new technology was emphasized in this patient population. A careful surveillance protocol and active endovascular treatment of complications can yield acceptable results and low AAA rupture and aneurysm mortality rates, also with the first-generation endovascular graft. A new technology, however, may involve unpredictable problems which can magnify the workload and incur high costs over several years after the initial procedure.

Background and Aims: Autogenous fistula should be constructed in a minimum of 50 of all new ESRD patients scheduled for haemodialysis. The radio-cephalic fistula described by Brescia and colleagues in 1966 is considered to be the access of choice due to its good patency and low complication rate. The aim of this study was to evaluate the outcome of primary access surgery in a well-defined geographical region in Finland. Material and Methods: All primary vascular access procedures between 1990–1999 were selected in the local vascular registry. Additional data was collected from patients' case records. Kaplan-Meier method was used to calculate fistula patency. Multivariate analysis of four variables (age, gender, diabetes mellitus, smoking) was done to determine their association with primary success Results: 407 primary procedures were done during the 10-year period including 405 (99.5 %) autogenous fistulas and two prosthetic grafts (0.5 %). 230 (56.8 %) fistulas were used for haemodialysis during the study. Cumulative primary functional patency at one year was 84.1 %, at two years 75.2 % and at five years 50.1 %. An attempt to salvage failing or failed fistula was done in only 15 (6.5 %) cases with insignificant impact on outcome. None of the tested variables was associated with poor functional success. Conclusions: The strategy of using native radio-cephalic fistula as a first access site results in excellent early and long-term functional patency for ESRD patient.