Endovascular Aortic Repair: A Kenyan Perpective
PREMANAND PONOTH, Dr, ANTONY GIKONYO, Dr
THE KAREN HOSPITAL,NAIROBI,, NAIROBI, Kenya
Back ground& Objective Aortic disease incidence is increasing in Kenya , even though open surgical repair has been the standard of care traditionally. We present twenty eight cases of endovascular repair at our centre over a period of 36 months. This technique is an ideal alternative to open repair, as it carries low morbidity and mortality. Materials & Methods Our experience on endovascular aortic repair between Januarys 2018 to December 2020 is reported. Total of 28 cases were treated, of which 20 were male and 8 female. Age varied from 16-84 years. One of the female patient has rapture of the thoracic aneurysm and had TEVAR on an emergency basis. All patients had Valiant Captiva stent (Medtronics) as per the individual measured size.16 year old boy had coarctation stenting. Results: The only mortality was a patient who had acute rapture proximal to the stent site in the immediate post-operative period. 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 abdominal aortic aneurysm repair was in 1994 (Dr Chuter). In 2010, endovascular aneurysm repair, accounted for 78% of all intact abdominal aortic aneurysm repair in the United States. Between 1998 to 2007,264 patients (92 male and 172 female patients) had 60% successful open repair of abdominal aortic aneurysms in Kenya. Hypertension were 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. Easy availability of all sizes of stent graft is of concern when we deal emergency situations. 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 in spite of economic challenges.