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Objective: Early outcomes of open abdominal repair (OS) versus endovascular repair (EVAR) for abdominal aortic aneurysm were retrospectively analyzed, after commercialized devices for EVAR had become available in Japan. Patients and Methods: A total of 781 consecutive patients (OS, n = 522; EVAR, n = 259) were treated at ten medical centers between January 2008 and September 2010. The OS group comprised patients with preoperative shock (SOS, n = 34) and without shock (NOS, n = 488). Results: Patients in the EVAR group were 3 years older than those in the NOS group. There was greater prevalence of hostile abdomen, on dialysis, chronic obstructive pulmonary disease on inhaled drug, and cerebrovascular disease in the EVAR group than in the NOS group. Surgical mortality was 16 cases (2.0% in all patients, EVAR: 0.8%, NOS: 1.4%, SOS: 21%). Hospital stay >30 days was documented in 52 (11%) with NOS, 11 (33%) with SOS, and 8 (3%) with EVAR. Thirty late deaths included 6 aneurysm related death and 14 cardiovascular causes at a mean follow up of 1.0 year. The survival rates freedom from all cause death at one year, were 95 ± 1% in NOS and 94 ± 2% in EVAR respectively. Conclusion: Though significant differences in patient characteristics among three groups were noted, early results were satisfactory.

Objective: Patients and Methods: In order to assess the early outcomes of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) in the Japanese population, a total of 183 patients who had EVAR at eight medical centers of the National Hospital Organization were retrospectively reviewed and registered. The mean number of registered cases in each center was 23 ± 17 (4–50 cases). Patient characteristics were male sex, 84%; mean age, 77 years; age ≥ 80 years, 40%. Results: In-hospital mortality was one case (0.5%). Endoleaks were observed at the end of the procedure in 35 patients (19%: type I: n = 4, II: n = 22, III, n = 3, IV: n = 6). Early morbidity included delayed wound healing or infection (n = 7), deterioration of renal dysfunction (n = 3), stroke (n = 2), postoperative bleeding (n = 2), gastrointestinal complications (n = 2), and peripheral thromboembolism (n = 2). Eleven late deaths included one of unknown cause and six cardiovascular causes at a mean follow up of 1.0 year. Survival rates of freedom from all causes of death and from aneurysm-related death at one year were 95.4% ± 1.7% and 99.5% ± 0.5%, respectively. Interpretation: Although registered patients carry a variety of risks, early outcomes were satisfactory. EVAR is an acceptable alternative treatment modality for treating AAA.

This case report details our experience with endovascular stent-graft repair for an abdominal aortic aneurysm (AAA) in a patient who was previously treated by left ventricular remodeling for dilated cardiomyopathy. Renal dysfunction with an elevated creatinine level (1.59 mg/dl) was managed by reducing the dose of contrast medium utilizing intravascular ultrasonography. Using a Zenith AAA endovascular device, the aneurysmal sac was successfully excluded and was thrombosed. Endovascular stenting is a good treatment option for abdominal aneurysm repair in patients with poor heart function and renal impairment.

BACKGROUND The objective of the present study was to assess the hypothesis that the introduction of endovascular aneurysm repair (EVAR) into Japan has expanded the indication of abdominal aortic aneurysm (AAA) repair without increasing surgical mortality. METHODS AND RESULTS From 10 national hospitals, we registered a total of 2,154 consecutive patients (Open surgery [OS]: n=1,577, EVAR: n=577) over 8 years, divided into 4 time periods: Group I (2005-2006: n=522), Group II (2007-2008: n=475), Group III (2009-2010: n=551), Group IV, (2011-2012: n=606). Mean age increased over the 4 time periods (P

The present case report details our experience with the hybrid approach for multiple aneurysms in the aortic arch, thoracoabdominal aorta, and around the aortic bifurcation. Total arch replacement for the arch aneurysm under hypothermic cardiopulmonary bypass with antegrade cerebral perfusion was the first stage of aneurysm repair. Five months later, bifurcated graft replacement with debranching of four abdominal branches was undertaken as the second stage of treatment. Finally, stent-graft repair for chronic dissection of the thoracoabdominal aorta was performed utilizing a Gore-Tex Tag endovascular prosthesis. Over 7 months of treatment, all aneurysms were excluded from the aortic blood flow and pressure without abdominal organ dysfunction except a transiently elevated total bilirubin level. Although the patient had an episode of minor gastrointestinal bleeding after discharge, he is currently leading a normal life without limitations at home 5 months after the stent-graft repair.

Abdominal aortic dissection (AAD) is a rare pathology and potentially causes rupture or other serious complications. This case report details our experience in endovascular aneurysm repair for AAD in a patient who had a history of coronary bypass surgery. Circumferential dissection of terminal aorta showed stenosis of true lumen as well as blood flow present in the pseudolumen. Using Zenith AAA endovascular device, the entry site was closed and the pseudolumen was thrombosed successfully. In the present report, published data on AAD were reviewed and endovascular aneurysm repair as a treatment option has been discussed as well.

La dissection aortique abdominale (AAD) est une pathologie rare et cause potentiellement la rupture ou d’autres complications serieuses. Ce rapport de cas detaille notre experience de la reparation endovasculaire d’anevrysme d’une AAD chez un patient qui avait un antecedent de pontage coronarien. La dissection circulaire de l’aorte terminale montrait une stenose de la vraie lumiere et un flux sanguin dans la fausse lumiere. Avec un dispositif endovasculaire Zenith pour AAA, la porte d’entree etait fermee et la fausse lumiere thrombosee avec succes. Dans le present rapport, les donnees publiees sur les AAD ont ete revues et la reparation endovasculaire comme option therapeutique est discutee.