Simplified repair of abdominal aortic aneurysms using non-bifurcated (straight) inlay prostheses

Abstract

The treatment of abdominal aortic aneurysms by prosthetic replacement is still attended by considerable hospital mortality, particularly when rupture has already occurred. We consider that the results could be significantly improved by the more widespread use of a simplified repair which consists of the insertion of a non-bifurcated (straight) tubular inlay prosthesis within the aneurysm. No attempt is made to resect or to transect the aorta and its bifurcation is preserved. In a series of 61 consecutive patients, from which 4 were excluded because they died before definitive surgery, there were 30 intact and 27 ruptured aneurysms. The hospital mortality for prosthetic replacement of intact aneurysms was 15 per cent using bifurcation grafts in 20 patients and nil for straight prostheses in 10 patients. The respective figures for leaking aneurysms were 64 per cent in 14 patients and 38 per cent in 13 patients. In our experience this simplified technique has resulted in diminished hospital mortality as a consequence of reduced operating times, blood loss and postoperative morbidity. It can, moreover, be universally employed except where gross separation of the origin of the common iliac vessels has occurred, which is uncommon, or in the rare instance of coexistent acute limb ischaemia.