Abdominal
Aortic Aneurysm Repair by Principle of Exclusion and Aortic Bypass: Single
Centre Experience
Sandeep M* and Ramakrishna P
Department
of Vascular Surgery, Nizam’s Institute of Medical Sciences, Punjagutta,
Hyderabad, India
Abstract
Purpose: Non-respective treatment of the abdominal aortic aneurysm by proximal and distal ligation of the aneurysm sac (exclusion) combined with aortic bypass known as Debakey Procedure has been previously reported. A 2 year experience with 10 patients undergoing this procedure was reviewed.
Methods: From 2010 to 2012, 10 patients of abdominal aortic aneurysm underwent repair with the retroperitoneal exclusion technique. Preoperative morbidity and mortality, blood loss and transfusion requirements, naturally of the excluded aneurysm sac were all assessed.
Results: The operative mortality rate for patients undergoing exclusion and bypass was 10% (one out of 10 patients). The incidence of nonfatal preoperative complications was 5%. Blood loss requiring transfusion in the preoperative period measured 600 mL to 900 mL on an average. On follow-up, only one out of 10 patients was found to have patent aneurysm sacs as detected by duplex examination which required surgical Intervention. No cases of graft infection or Aorto-enteric fistula have been noted.
Conclusion: Retroperitoneal exclusion and bypass is a viable alternative to traditional open endoaneurysmorraphy in surgery for abdominal aortic aneurysm. Most excluded aneurysm sacs have thrombosis without any long or short-term complications; however, in a small number of patients delayed rupture of patent aneurysm occurs, thus emphasizing the need for diligent follow-up and appropriate intervention.
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