Endovascular Repair: Paradigm Shift In Surgical Treatment In Kenya
Premanand PONOTH, Dr., Antony GIKONYO, Dr..
THE KAREN HOSPITAL, NAIROBI, Kenya.
Background & Objective Aortic aneurysm incidence is increasing in Kenya. Open surgical repair has been the standard of care. We present 10 cases of endovascular aneurysm repair at a single centre over a period of 23 months. This technique may be a suitable alternative to open repair, especially in a low volume centre and provide a higher success rate of repair. Materials & Methods We report our experience of the management of aortic aneurysms using endovascular aneurysm repair stents between Januarys 2018 to December 2019.Total of 10 cases were treated, of which 6 were male and 4 female. Age varied from 47-68 years. One of the female patient has rapture of the thoracic aneurysm and had TEVAR on an emergency basis. All patients had as per the individual measured size stents. Of all the cases 8 were abdominal and 2 were thoracic aneurysms. Results: There was 1 mortality. This patient had acute rapture proximal to the stent site in the immediate post-operative period and another one patient had superficial groin infection which was treated with antibiotics. All the patient did well and was discharged in 5 days, except for the female patient as an emergency, who was discharged on the 10th day. Discussion The first endovascular repair of an abdominal aortic aneurysm (EVAR) was performed by Dr. Juan Parodi in 1990 in Argentina. The first clinical experience with Trans femoral insertion of an endovascular bifurcated graft for repair of an abdominal aortic aneurysm was in 1994 by Dr Chuter. In 2003, EVAR surpassed open surgical repair, as the most common technique for repair of aortic aneurysm repair. A retrospective study in Kenya, from1998 to 2007 found two hundred sixty-four (92 male and 172 female patients), mean age was 56.15 years, 84.5% abdominal aortic aneurysms with sucessful open surgical repair in 60% of patients. Hypertension was the leading risk factor. The learning curve for endovascular repair, allowed a quicker transfer of skills from proctor to trainee team, to independently perform these procedures safely with an acceptable 30-day mortality rate Conclusion In a low volume centre, endovascular repair may be a preferable approach with 30 day outcomes similar to high volume open repair centres. We conclude that this is an ideal treatment methodology instead of open surgery which has high morbidity and mortality.
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