open access

Vol 9, No 3 (2007)
Published online: 2008-01-04
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Dacron mesh wrapping of an abdominal aortic aneurysm - a treatment of choice or act of despair?

Krzysztof Ziaja, Wacław Kuczmik, Jacek Kostyra, Damian Ziaja, Przemysław Nowakowski, Grzegorz Biolik, Tomasz Urbanek
Chirurgia Polska 2007;9(3):130-139.

open access

Vol 9, No 3 (2007)
Published online: 2008-01-04

Abstract

Background: In 1948, Rea and Poppe wrapped the anterolateral surface of an aneurysm with reactive cellophane. They hoped the material would induce fibrosis within the surrounding tissues, causing reinforcement of the aneurysm wall and limiting its expansion. The technique remains in use, although rather sporadically, and mainly in high-risk patients who cannot be selected for endovascular repair.
Material and methods: From 1996 to 2004, 24 procedures of dacron wrapping of abdominal aortic aneurysms were performed in our Department. Patients selected for AAA wrapping procedure were high-risk surgical candidates with low left ventricular ejection fraction < 35%. All required urgent intervention due to the symptomatic character of the aneurysm or fast growth of its diameter (> 10 mm/year). They had been previously disqualified as candidates for conventional repair by a consulting cardiologist and anaesthesiologist. Since 2000, aneurysm wrapping has been used in patients unsuitable for endovascular approach due to unfavourable anatomical features.
Results: The mean duration of surgery varied between 50 and 140 minutes. Intraoperative blood loss on average was 408 ml. Mean hospital stay was 8.53 days. Myocardial infarction was found in 5 of our patients (20.8%). Four (16.6%) developed circulatory insufficiency with a considerable drop in blood pressure and, in consequence, the administration of catecholamine treatment. Renal insufficiency observed prior to the procedure in one patient was exacerbated after surgery, with serum creatinine reaching 2.45 mg/dl. Due to respiratory insufficiency 8 patients (33.3%) required mechanical ventilation continuing for 4 to 18 hours. The perioperative mortality rate was 16%. Following partial aneurysm wrapping, a marked increase in aneurysm diameter was found during a check-up CT in two cases; one aneurysm rupture resulted.
Conclusions: Aneurysm wrapping carries a rather insignificant risk to the patient. Aortic clamping can be avoided, which is mainly responsible for cardiological complications in patients with cardiovascular disease and low left ventricular ejection fraction (EF LV). Until further refinements in endograft technology are made and introduced to practice, such as fenestrated stent-grafts, complete dacron wrapping remains a method of relatively effective and safe AAA repair in high-risk patients disqualified as candidates for conventional open repair and stent-grafting.

Abstract

Background: In 1948, Rea and Poppe wrapped the anterolateral surface of an aneurysm with reactive cellophane. They hoped the material would induce fibrosis within the surrounding tissues, causing reinforcement of the aneurysm wall and limiting its expansion. The technique remains in use, although rather sporadically, and mainly in high-risk patients who cannot be selected for endovascular repair.
Material and methods: From 1996 to 2004, 24 procedures of dacron wrapping of abdominal aortic aneurysms were performed in our Department. Patients selected for AAA wrapping procedure were high-risk surgical candidates with low left ventricular ejection fraction < 35%. All required urgent intervention due to the symptomatic character of the aneurysm or fast growth of its diameter (> 10 mm/year). They had been previously disqualified as candidates for conventional repair by a consulting cardiologist and anaesthesiologist. Since 2000, aneurysm wrapping has been used in patients unsuitable for endovascular approach due to unfavourable anatomical features.
Results: The mean duration of surgery varied between 50 and 140 minutes. Intraoperative blood loss on average was 408 ml. Mean hospital stay was 8.53 days. Myocardial infarction was found in 5 of our patients (20.8%). Four (16.6%) developed circulatory insufficiency with a considerable drop in blood pressure and, in consequence, the administration of catecholamine treatment. Renal insufficiency observed prior to the procedure in one patient was exacerbated after surgery, with serum creatinine reaching 2.45 mg/dl. Due to respiratory insufficiency 8 patients (33.3%) required mechanical ventilation continuing for 4 to 18 hours. The perioperative mortality rate was 16%. Following partial aneurysm wrapping, a marked increase in aneurysm diameter was found during a check-up CT in two cases; one aneurysm rupture resulted.
Conclusions: Aneurysm wrapping carries a rather insignificant risk to the patient. Aortic clamping can be avoided, which is mainly responsible for cardiological complications in patients with cardiovascular disease and low left ventricular ejection fraction (EF LV). Until further refinements in endograft technology are made and introduced to practice, such as fenestrated stent-grafts, complete dacron wrapping remains a method of relatively effective and safe AAA repair in high-risk patients disqualified as candidates for conventional open repair and stent-grafting.
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Keywords

abdominal aortic aneurysm; high-risk patients; wrapping

About this article
Title

Dacron mesh wrapping of an abdominal aortic aneurysm - a treatment of choice or act of despair?

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 9, No 3 (2007)

Pages

130-139

Published online

2008-01-04

Bibliographic record

Chirurgia Polska 2007;9(3):130-139.

Keywords

abdominal aortic aneurysm
high-risk patients
wrapping

Authors

Krzysztof Ziaja
Wacław Kuczmik
Jacek Kostyra
Damian Ziaja
Przemysław Nowakowski
Grzegorz Biolik
Tomasz Urbanek

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