Endovascular and surgical techniques - AAA endografting: two straightforward indications?

Introduction renal arteries. The proximal neck of the aneurysm was 24 mm long and 23 mm wide, without thrombus or Endoluminal repair of infrarenal aneurysms of the calcifications, and consequently fit for endovascular abdominal aorta is still controversial. Much unfixation (Fig. 2). Preoperative kidney function was certainty continues to exist about its proper application normal (urea: 5.5 mmol/l and creatinine: 91 lmol/l). and its success and reliability. The patient was operated on under epidural anWe report two cases with different types of anaesthesia. An AneuRx 26/15/165 aortoiliac stent graft eurysms of the infrarenal abdominal aorta, in which was placed transfemorally, followed by a 16/115 iliac there is, in our view, a clear preference for endoluminal contralateral leg and two iliac extensions of 15/55 right exclusion of the aneurysm. and 16/55 left (Medtronic AVE, California, U.S.A.). Occlusion time of the aorta was 5.5 minutes, fluoroscopy time was 27 min, blood loss was 200 ml, and skin-to-skin time was 105 min. The postoperative course was uneventful, except for Cases a grade I wound infection of the right groin. The abdominal aorta was not painful on palpation any A 56-year-old man presented with a 2-week history more. The patient was fully ambulatory the day after of a progressive pain in the back and abdomen. The surgery. Postoperative kidney function remained norpatient was known to have an infrarenal aneurysm of mal (urea: 6.3 mmol/l and creatinine: 128 lmol/l). CT the abdominal aorta (diameter 40 mm) and a horseshoe scan and duplex scanning of the abdomen, on diskidney. On physical examination, the aorta was paincharge (fifth postoperative day) and after 12 months, ful. Pulsations in the femoral arteries existed. The showed no evidence of endoleak and a normal (horseankle–brachial index was 1.01 at the right and 1.00 at shoe) kidney function (Fig. 1B). The aneurysm size the left side. Preoperative work-up consisted of a spiral was decreased to 43 mm. computed tomography (CT) scan and an intra-arterial An 83-year-old man, who had recovered from a abdominal angiogram and resulted in an aneurysm of pneumococcal sepsis 6 months ago, was referred to the abdominal aorta with a largest diameter of 49 mm, our hospital with an asymptomatic saccular aneurysm expanding in the common iliac arteries. There was no of the infrarenal abdominal aorta with a diameter of significant angulation of the aortic neck, or iliac ar55 mm. Preoperative work-up consisted of spiral CT teries. The inferior mesenteric artery was occluded scan and intra-arterial abdominal angiogram, which and both the internal iliac arteries were patent. Both resulted in a saccular aneurysm with a largest diameter renal arteries divide high up, next to the superior of 60 mm. On spiral CT there was no evidence of aorta mesenteric artery (Fig. 1A). There were no aberrant wall infection. The erythrocyte sedimentation rate (ESR) was 20 mm/h. Therefore, an active mycotic aneurysm was unlikely. The inferior mesenteric artery ∗ Please address all correspondence to: R. H. Geelkerken, Deas well as both the iliac arteries were patent. There partment of Vascular Surgery, Medisch Spectrum Twente, P.O. Box: 50 000, 7500 KA Enschede, The Netherlands. was no significant angulation of the aortic neck, or