Alternativa quirúrgica de recurso en pacientes con AAA sintomático, sin indicación técnica de exclusión endovascular y elevado riesgo quirúrgico

Resumo

INTRODUCTION. The increase in life expectancy leads to a higher number of symptomatic patients with AAA with anatomical limitations for EVAR and high surgical risk in conventional open surgery, seeking treatment because they are not resigned to wait death from aneurysm rupture. An alternative is offered , reviving an old technique, extra-anatomic revascularization and aneurysm resection. Our goal is to analyze the results obtained with this therapeutic approach. MATERIALS AND METHODS. We treated 7 patients with a mean age of 78.8 years and symptomatic AAA (one with subsequent contained rupture) of 5.2 cm to 8 cm. in diameter. All had severe cardiorespiratory disease and anesthetic risk ASA III-IV. An axilobifemoral bypass and aneurysm resection was performed in all the cases. RESULT. The result was satisfactory in all patients with follow up between 1 and 15 years. As complications in the immediate postoperative: A pneumonia occurred in one case and a intestinal perforation in other case, satisfactorily resolved. After eight years of follow up there was one death by lung cancer. CONCLUSIONS. In view of these results, we believe that the axilobifemoral bypass and aneurysmal resection may be a useful therapeutic option for patients with symptomatic AAA with anatomical limitations for standard EVAR and high surgical risk , but we also believe that it should be a tailored treatment for each patient, reinforcing the idea that there is not outdated techniques only inopportune indications.