Biomedical subjects

H O Myhre

Publications and source records attributed to H O Myhre.

At least 19 recordsLinked to original sources

PubMed2006

The prevalence of chronic critical lower limb ischaemia in a population of 20,000 subjects 40-69 years of age.

OBJECTIVE: To study the prevalence and possible risk factors for chronic critical lower limb ischaemia (CLI) in an unselected population of 20,291 Norwegian men and women 40-69 years of age. METHODS: Between 1995 and 1997, all residents 20 years or older in Nord-Trøndelag County, Norway, were invited to participate in a population study (the HUNT 2 Study). Among the 71.2% who attended, 20,291 participants 40-69 years of age responded to questions specifically aimed at identifying CLI. Chronic critical ischaemia was suspected if participants indicated: (1) ulcers on toes, foot or ankle that had failed to heal and/or; (2) persistent pain in the forefoot while in the supine position, but with relief of this pain when standing up. Using logistic regression analyses, we estimated the association between the prevalence of CLI and smoking, diabetes mellitus, previous cardiovascular events, blood lipids and glucose levels, and body mass index (BMI). RESULTS: The age-adjusted prevalence of CLI was 0.26% among men and 0.24% among women, and there was no gender difference in any age group (age-adjusted OR = 0.91, 95% CI = 0.52-1.58). The presence of increased age, diabetes mellitus, angina pectoris, high triglyceride levels, and high BMI were all independently associated with higher prevalence of CLI. CONCLUSION: The prevalence of CLI was 0.24%, similar for both genders, and increased with age. Risk factors usually seen in atherosclerotic patients were associated with suspected CLI.

Adult↗

PubMed2006

Data quality of surgery for carotid artery stenosis. Are the national vascular registries reliable?

OBJECTIVES: To study completeness of reporting carotid endarterectomies, including peri-operative stroke and mortality rate, in a national vascular registry, NorKar, and a national administrative registry, The Norwegian Patient Register (NPR). DESIGN: Comparative registry-based national study. MATERIALS: Member hospitals of NorKar, including 89% of carotid endarterectomies in Norway, were compared with relevant data in NPR for the years 2000-2002. METHODS: We compared procedure-codes, diagnosis-codes, in-hospital death and the occurrence of peri-operative stroke after treatment for carotid artery stenosis in the two registries to evaluate completeness. RESULTS: Compared with the NPR numbers, 16% of carotid endarterectomies were missing in the reports from member hospitals of NorKar. Further, during this three-year period, there was an under-reporting of seven strokes and two deaths. The discrepancy was most pronounced in 2001. CONCLUSIONS: There is an under-reporting of patients operated on for carotid artery stenosis in NorKar according to NPR numbers as well as an under-reporting of early deaths and strokes. There is a need for better quality data in the NorKar Registry. Registry quality would be likely to improve if patient identifiable data were available in both registries.

Angioplasty, Balloon↗

PubMed2006

Spinal fluid dynamics during thoracic- and thoracoabdominal aortic surgery.

AIM: The intention was to investigate cerebrospinal fluid pressure (CSFP) and volume of cerebrospinal fluid (CSF) drained during and after thoracic- and thoracoabdominal aneurysm repair. The findings were related to the occurrence of postoperative neurologic deficits. METHODS: Twenty-nine patients (12 with thoracic and 17 with thoracoabdominal aortic aneurysm) were operated without shunting or extracorporeal circulation. For monitoring of CSFP an intrathecal catheter was placed in all patients. The volume of CSF withdrawn intraoperatively, on the day of operation as well as on the 1st and 2nd postoperative day was recorded. RESULTS: Twenty-six patients had no postoperative neurologic sequelae. One patient had postoperative paraplegia while 2 had paraparesis. The three patients with neurologic sequelae had higher CSFP intraoperatively than those without neurologic symptoms (P=0.04). Median CSFP during aortic cross-clamping was 19 mmHg and 10 mmHg and the median volumes of CSF drained on the day of operation 210 and 85 mL in the two groups, respectively. There was a significant positive correlation between CSFP and central venous pressure. CONCLUSIONS: A higher intraoperative CSFP was observed in patients with neurologic sequelae following thoracic- and thoracoabdominal aneurysm repair. Further, there was a tendency of higher volumes of CSF drained in this group of patients. Although, the series is too small to allow firm conclusions, it supports the view that CSFP monitoring and drainage is beneficial during thoracic- and thoracoabdominal aneurysm repair.

Aged↗

PubMed2006

Carotid endarterectomy: time-trends and results during a 20-year period.

AIM: The aim of this study was to evaluate the results following surgery for carotid artery stenosis in a single institution during a 20-year period. METHODS: In a retrospective study, 556 operations were performed in 496 patients during the period 1983-2002. Comorbidities, mortality, stroke and other surgical and general complications were recorded. Follow-up was performed and data retrieved from medical records, questionnaires, and visits to local hospitals. Data on late mortality were retrieved from the Norwegian Registrar's Office of birth and deaths. RESULTS: The mean age was 66.9 years (range 43-84 years), and 60% were men; 84% had symptomatic carotid artery stenosis. General anesthesia was applied in 95.5%. A shunt was used in 61.3%, and patch angioplasty in 95.1%. Autologous vein patch was used in almost all cases and there were no cases of patch rupture. Postoperative myocardial infarction occurred in 16 (2.9%) of the patients, and 5 were fatal. All types of stroke within 30 days of surgery occurred in 23 (4.1%) including 1 fatal stroke, and 7 patients died of other causes. The total stroke/mortality rate was 5.4%. Patients with previous coronary artery bypass had a favorable outcome regarding long-time survival. In contrast, increasing age, diabetes, renal failure and intermittent claudication predicted reduced long-term survival. No operations were performed for recurrent stenosis. CONCLUSIONS: We have used fairly the same policy regarding operative technique during the 20-year period and the results are in agreement with those presented in large international trials. The long-term results were favorable, and improved over time, probably due to better preoperative evaluation of the patients, better timing of surgery and treatment of comorbidities.

Adult↗

PubMed2006

Is insulin growth factor-1 (IGF-1) playing a role for aneurysm formation in patients with pituitary gland tumor?

The combination of pituitary gland tumor and aneurysmal disease has previously been described. Most of these aneurysms have affected intracranial arteries. The purpose is to present 2 patients with thoracoabdominal aortic aneurysm and pituitary gland tumor and further to discuss the mechanism behind this combination of diseases. A 59-year-old male patient was admitted with abdominal pain and a 120 mm thoracoabdominal aortic aneurysm type III. He was operated with resection and graft replacement. During the operation, it was noted that his intra-abdominal arteries were extremely enlarged. The diagnosis acromegaly was confirmed in the late 50's and he had received irradiation therapy and underwent partial trans-sphenoidal hypophysectomy. His growth hormone values eventually declined while he had elevated insulin growth factor-1 (IGF-1) levels. The patient died from stroke 6 years after operation. Patient n. 2 is a 73-year-old female with a type II thoracoabdominal aortic aneurysm. She was operated for a pituitary adenoma in 1988. There were no clinical or biochemical signs of acromegaly. However, she had elevated serum values of IGF-1. The maximum diameter of the aneurysm was 60 mm. Because of comorbidity the patient has been followed at the outpatient clinic. The mechanism behind the combination of pituitary gland tumor and aneurysm is obscure. One of our patients had classical acromegaly. Growth hormone decreased over the years, while his IGF-1 values were normal or elevated. The other patient had increased levels of IGF-1 without typical acromegaly. This might indicate that IGF-1 could play a role in the development of aneurysm in patients with pituitary tumor. This combination of diagnoses should be kept in mind when dealing with patients having aneurysmal disease.

Adenoma↗

PubMed2005

Serum lipids and anthropometric factors related to the prevalence of intermittent claudication.

PURPOSE: To study serum lipids, body mass index (BMI), and body shape in relation to intermittent claudication (IC) in 19,748 men and women 40-69 years of age. METHOD: All residents (1995-1997) in Nord-Trøndelag County, Norway, were invited to attend the cross sectional study and received a Norwegian translation of the WHO/Rose questionnaire on intermittent claudication and the Edinburgh claudication questionnaire. Blood lipids and anthropometric data were measured at a consecutive examination. Odds ratios (OR) were estimated for associations with IC by multiple regression analysis. RESULTS: The ratio of total cholesterol to HDL cholesterol (TC/HDL cholesterol) (P trend(men)=.023; P trend(women)<.001) and triglycerides (P trend(men)=.029; P trend(women)=.002) were positively associated with the prevalence of IC. HDL cholesterol was negatively (P trend(men)=.131; P trend(women)<.001) associated, whereas BMI (P trend(women)=.032), waist circumference (P trend(women)=.021), and hip circumference (P trend(women)=.020) were positively associated with IC in women, but not in men. Adjustment for smoking, diabetes, and systolic or diastolic blood pressure did not change the results. CONCLUSION: TC/HDL cholesterol and triglycerides were positively, and HDL cholesterol negatively associated with IC in both genders. In women, but not in men, BMI, waist and hip circumference were positively associated with IC.

Adult↗

PubMed2005

Quality of data reported on abdominal aortic aneurysm repair--a comparison between a national vascular and a national administrative registry.

OBJECTIVE: To study consistency of data and completeness of reporting in a national vascular registry, NorKar, and a national administrative registry, The Norwegian patient register (NPR). DESIGN: Comparative registry-based national study supplemented with a comprehensive control of patients registered in one major hospital. MATERIAL: All patients registered with a procedure-code for treatment of AAA in NorKar or NPR during 2001 or 2002, were included. METHOD: We compared the reporting of procedure-codes, diagnosis-codes and in-hospital deaths after treatment for abdominal aortic aneurysm (AAA) in the two registries to evaluate completeness. Consistency between procedure-codes and diagnoses were evaluated within both registries. Completeness of reporting to one NorKar Local Registry was investigated in more detail in one of the hospitals. RESULTS: Compared with the NPR numbers, NorKar contained 69% of the patients treated for AAA in Norway, while completeness for NorKar member hospitals was 84%. The detailed investigation in one of the hospitals showed a completeness of 91% and a false inclusion of 5.3% of all cases treated for AAA. The consistency between procedure-codes and diagnosis-codes was 93% in both registries. We found evidence of substantial underreporting of in-hospital deaths to NorKar in several hospitals. Overall reporting of early deaths to NorKar relative to completeness of reported cases was estimated to 72%. CONCLUSION: There is an underreporting of patients with AAA to NorKar according to the NPR numbers and a need for better control of procedure-diagnosis consistency in both registries. There seems to be a substantial underreporting of early deaths to NorKar. Introduction of unique patient-identifiable data could improve the quality of both registries by making matching of data possible.

Angioplasty, Balloon↗

PubMed2005

Results of endovascular repair of inflammatory abdominal aortic aneurysms. A report from the EUROSTAR database.

OBJECTIVES: To investigate the results following endovascular treatment of patients with inflammatory abdominal aortic aneurysms (IAAA). DESIGN: Retrospective study based on the EUROSTAR registry. MATERIAL AND METHODS: Patients included in the EUROSTAR registry with IAAA (n=52, 1.4%) were compared to those having aneurysms without aortic fibrosis (n=3613, 98.6%). The mean follow-up period in patients with IAAA was 23 months (range 1-60). In 11 of the patients detailed information on the effect of endovascular repair and perianeurysmal fibrosis and ureteral entrapment was obtained by a dedicated questionnaire. RESULTS: Twelve patients (23%) with IAAA had preoperative impairment of renal function and five had known hydronephrosis. Variables that were significantly associated with IAAA included younger age (p<.0001, mean difference 5.9, CI 3.7-7.9) and lower pulmonary risks score (OR 0.38, CI 0.19-0.74). At completion of the endovascular procedure, device stenosis was more frequently observed in patients with IAAA (OR 18.1, CI 3.52-93.0). There were no differences with regard to the rates of mortality, rupture or conversion in patients with IAAA and controls. In the majority, the aneurysm size regressed irrespective of nature of aneurysm. Of the 11 patients with a detailed assessment three had deterioration of renal function and three still had ureteral entrapment during follow-up. CONCLUSION: Despite persistence of perianeurysmal inflammation in a proportion of patients operative and midterm results of endovascular repair were comparable in the patients with inflammatory and standard AAA.

Adult↗

PubMed2005

Elective open operation for abdominal aortic aneurysm in octogenarians--survival analysis of 105 patients.

OBJECTIVES: To study early mortality and long-term survival of patients more than 80 years of age having elective open repair for abdominal aortic aneurysm (AAA). DESIGN: Retrospective multicenter cohort study. MATERIAL: One hundred and five patients, 23 women and 82 men, with a median age of 82 years, operated at three Norwegian hospitals during the period 1983-2002. METHOD: Survival analyses were based on data from medical records and the Norwegian Registrar's Office of Births and Deaths. Expected survival was based on mortality rates of the general population, matched by age, sex, and calendar period. Relative survival was calculated as the ratio between the observed and the expected survival. RESULTS: During the study period there has been a 10 fold increase in octogenarians treated with open operation for AAA. Early mortality (30-day) for the whole group of patients was 10.5% (95% confidence interval (95% CI) 5.3-18.0), and similar for both genders. The 5-year survival rate was 47% (95% CI 35.9-57.4), and not significantly different from that of a matched group in the general population. Patients aged 84 years or more had a median survival time of 35 months (95% CI 18.5-51.6). CONCLUSION: The number of AAA operations in octogenarians has increased considerably during 20 years. Octogenarians operated electively for AAA has higher 30-day mortality as compared to younger patients. Their long-term survival appears similar to a matched control group. The benefit of surgery must be carefully considered against the perioperative risk, especially for the oldest octogenarians.

Age Factors↗

PubMed2005

Ruptured abdominal aortic aneurysm secondary to tuberculous spondylitis.

A 69-year-old man was admitted with low back pain and signs of nerve root compression. A computed tomography (CT) scan showed abscess formation in the left psoas region, spondylodiscitis L3-L4 and a ruptured abdominal aortic aneurysm. The aortic aneurysm was replaced with a bifurcated vascular graft. One week later, laminectomy at the L4-level was done. In a small abscess, Mycobacterium bovis was found. The condition was considered to be a mycobacterial spondylitis secondary to BCG instillations of the urinary bladder for carcinoma. The patient received antituberculous medication for 9 months. Subsequently bone transplantation and internal fixation of the spine became necessary. Three years after surgery he is in good condition and there are no signs of graft infection on CT. Spondylitis and mycotic aortic aneurysm should be kept in mind in patients who have been treated for carcinoma of the bladder with BCG instillations.

Aged↗

PubMed2005

Recovery following treatment of descending thoracic aortic disease. A comparison between endovascular repair and open surgery.

AIM: The aim of this study was to compare the postoperative course in patients treated by endovascular repair (endo) with patients treated by open surgery (open) for descending thoracic aortic disease. METHODS: Twenty-five patients treated with stent grafting for aneurysmal disease or type B dissection were compared with 35 historical controls treated by open surgery. Stay in the intensive care unit, need for artificial ventilation and to where the patient had been discharged, were noted. Pain medication, use of nasogastric tube, time until total oral nutrition, mobilization and the patients' mental condition in the postoperative period, were studied in the patients charts and the nursing reports. RESULTS: Time on the intensive care unit or intermediate care unit was median 45 h in the endo group compared with 192 h in the open group. Eighty percent of the patients in the endo group were discharged directly to their homes in contrast to 23% after open surgery. In the endo group 67% of the patients started oral nutrition on the 1st postoperative day compared to 10% in the open group. There was a significantly faster mobilization in the endo group. CONCLUSIONS: There was a significantly shorter recovery after stent grafting for descending thoracic aortic disease compared to patients operated with open surgical technique.

Aged↗

PubMed2004

A strategy for treatment of type III and IV thoracoabdominal aortic aneurysm.

The aim of this study was to describe the results of resection and graft replacement for type III and IV thoracoabdominal aortic aneurysm repair. In this retrospective study, 27 patients underwent resection and graft replacement for type III (10) or type IV (17) thoracoabdominal aortic aneurysms. Nine patients had rupture, 12 were symptomatic, and 6 were operated on electively. The "clamp-and-sew" technique was applied in six cases. In 12 patients with type IV aneurysm the proximal part of the vascular graft was beveled, including the orifices of the celiac, superior mesenteric, and one or both renal arteries in the proximal anastomosis. Finally, eight patients underwent surgical application of a shunt for perfusion of the celiac and superior mesenteric arteries. One patient was treated with a combination of open and endovascular surgery. There were four early deaths (14.8%), all following operations for rupture, which represents a 45% mortality rate in this subgroup of patients. Two patients with type III aneurysm had postoperative paraparesis. One was symptomatic whereas the other was operated on electively. Excluding the patients with rupture, the accumulated 5-year survival rate was 65%. These results indicate that direct cross-clamping of the aorta gives limited time for performing the necessary anastomoses without inducing mesenteric ischemia. Inclusion of the orifices of the visceral arteries in the upper anastomosis is a feasible method during surgery for type IV aneurysms. Finally, shunting of the celiac and the superior mesenteric arteries seems to be useful, especially during surgery for type III aneurysms.

Aged↗

PubMed2004

Emergency non-ruptured abdominal aortic aneurysm.

OBJECTIVES: To investigate symptoms and early mortality (<30 days) following open surgery for emergency, symptomatic non-ruptured abdominal aortic aneurysm (AAA). DESIGN: Retrospective cohort study. PATIENTS AND METHODS: During the period 1983-1994, 129 patients had an emergency admission, followed by surgery, for symptomatic non-ruptured AAA. Sixty-one received surgery within 24 h of admission and 68 received surgery more than 24 h after admission (median 135 h, inter-quartile range: 51-239 h). During the same period 239 patients had elective surgery for non-ruptured AAA. Early mortality (<30 days), symptoms and co-morbidities were recorded. Data were retrieved from the patient records. RESULTS: Mortality (30 days) was 18% in the 61 patients having surgery within 24 h of emergency admission for non-ruptured AAA. Mortality following either delayed surgery (semi-elective) after emergency admission or elective surgery was 4.2% (p=0.0002). Four out of 11 patients who died within 30 days following an acute operation had previously been declared unfit for elective surgery. One additional emergency patient had been found unfit for open surgery, but survived a delayed operation. CONCLUSION: The high mortality rate of patients with non-ruptured, symptomatic AAA undergoing surgery within 24 h of admission appears to be influenced by several factors, including co-morbidities and the acute operation. We propose that the 30-day mortality for non-ruptured AAA should be reported in two categories: mortality rate for elective surgery and mortality for surgery performed within 24 h of emergency admission. The term 'emergency non-ruptured' is a suitable term for the latter group.

Aged↗

PubMed2003

Inflammatory aortic aneurysm is associated with increased incidence of autoimmune disease.

OBJECTIVE: It has been suggested that certain genetic risk factors indicative of an autoimmune mechanism can be identified in patients with inflammatory aortic aneurysm (IAA). We therefore investigated whether there was a higher incidence of autoimmune diseases in patients with IAA. Further, we explored risk factors, need for in-hospital resources, and early results of treatment, in a case-control study in a university hospital setting. Material and methods From 1983 to 1994, 520 patients were operated because of abdominal aortic aneurysm (AAA). Thirty-one patients had IAA. Control subjects were matched for aneurysm rupture, emergency or elective hospital admission, and date of operation. Two noninflammatory AAA were included for every IAA. RESULTS: Of the 31 patients with IAA, 6 patients (19%) had autoimmune disease, compared with none of the control subjects (P =.0017). Two patients had rheumatoid arthritis, 2 patients had systemic lupus erythematosus, 1 had giant cell arteritis, and 1 patient had an undifferentiated seronegative polyarthritis diagnosed as rheumatoid arthritis. Nineteen patients (61%) with IAA had involvement of the duodenum, and 8 patients (26%) had hydronephrosis with ureteral involvement. Operating time was longer in the IAA group, which also had a higher need for blood transfusion. Hospital stay, intensive care unit stay, and 30-day mortality were similar in the two groups. CONCLUSION: Except for longer operating time and more need for blood transfusions in the IAA group, use of hospital resources was similar after operations to treat IAA or noninflammatory AAA. The study findings indicate an association between IAA and autoimmune disease. This is in accordance with other reports that showed a genetic risk determinant mapped to the human leukocyte antigen (HLA) molecule in these patients. Further research is necessary to explore whether IAA might be a separate entity with a role of antigen binding in the origin of the disease.

Age Distribution↗

PubMed2003

Shunting of the coeliac and superior mesenteric arteries during thoracoabdominal aneurysm repair.

OBJECTIVES: To describe our experience with shunting of the coeliac and superior mesenteric arteries during thoracoabdominal aneurysm repair. DESIGN: Retrospective study. MATERIAL: Eight patients undergoing resection and graft replacement of Crawford type III (5) and type IV (3) thoracoabdominal aortic aneurysms were included in this series. One patient had rupture, four were symptomatic and three were operated on electively. METHODS: A vascular graft with a sidearm was applied for the reconstructions. A T-shunt was connected to the sidearm. Following completion of the proximal anastomosis the shunt was inserted into the coeliac and superior mesenteric arteries. The anastomoses to these arteries and the renal arteries were then completed. Finally the distal anastomosis was performed. RESULTS: There was no early mortality (30 days). One patient had postoperative paraparesis, but recovered quite well. Reoperation became necessary due to sigmoid necrosis in one patient and due to haemorrhage in another. During the follow-up period four patients died but the other patients are alive between 3 and 8 years after surgery. CONCLUSION: The application of shunting of the superior mesenteric and coeliac arteries during thoracoabdominal aortic surgery is feasible and the results have been acceptable. Further investigation of the optimal blood flow needed to avoid intestinal ischaemia in a larger series of patients is desirable.

Aged↗

PubMed2003

The prevalence of intermittent claudication. Sex-related differences have been eliminated.

OBJECTIVES: to investigate the prevalence of intermittent claudication (IC) in an unselected population of nearly 20000 individuals between 40 and 69 years of age. DESIGN: epidemiologic investigation of residents in Nord-Trøndelag County, Norway. MATERIAL AND METHODS: between 1995 and 1997, all residents 20 years of age or older in Nord-Trøndelag County, Norway, were invited to attend the HUNT Study. A total of 19748 participants between 40 and 69 years of age responded to questions related to the symptoms of intermittent claudication. We estimated the prevalence of IC based on these questions. RESULTS: the age-adjusted prevalence of intermittent claudication in the total population was 1.1% for men and 1.2% for women. We found an increase in the prevalence of IC by age, however, no sex differences were observed. CONCLUSION: the prevalence of intermittent claudication increased gradually by age. However, in contrast to previous reports, there was no difference by sex.

Adult↗

PubMed2003

The prevalence of asymptomatic arterial obstruction in the lower extremities among men and women 60 to 69 years of age.

AIM: To estimate the prevalence of asymptomatic arterial obstruction in the lower extremities in men and women 60 to 69 years of age. METHODS: A sample of 333 participants between 60 to 69 years of age attended a physical examination as part of a population based health study in Nord-Trøndelag County, Norway (the HUNT Study). The total prevalence of arterial obstruction was defined as the proportion of subjects with ankle brachial pressure index lower than 0.9 (ABPI<0.9). Further, the proportion of participants with arterial obstruction who also reported symptoms of intermittent claudication was defined as having symptomatic arterial obstruction. Finally, the prevalence of asymptomatic arterial obstruction was calculated as the difference between the total prevalence of arterial obstruction and the prevalence of symptomatic arterial obstruction. RESULTS: The total prevalence of arterial obstruction as defined by ABPI<0.9 was 7.8%. The prevalence was slightly higher among men (9.2%) than among women (6.9%), but the difference was not statistically significant (p-value=0.5). The prevalence of asymptomatic arterial obstruction was 6.3%, indicating that asymptomatic disease was approximately 4 times as frequent as symptomatic arterial obstruction (1.5%). The prevalence of asymptomatic arterial obstruction was nearly identical for men (6.2%) and women (6.4%). CONCLUSION: The total prevalence of arterial obstruction as defined by an ABPI<0.9 was 7.8% in this age group, and the prevalence of asymptomatic disease was 6.3%. Thus, only 1 in 5 persons who had objectively measured arterial obstruction indicated symptoms of intermittent claudication.

Aged↗

PubMed2001

Endovascular treatment of type B aortic dissections.

The purpose is to describe our experience with endovascular treatment of type B aortic dissections. Five patients were treated for complications following type B dissections like, false channel aneurysm formation, rupture and arterial obstruction. They were treated in general anaesthesia using a 'homemade' endoprosthesis or a commercially available endoprosthesis (Excluder) deployed during fluoroscopy. The patients have been followed at regular intervals with a median observation time of 18 months (range 12--36). One patient needed a secondary intervention due to dislodgement of the proximal stentgraft with haemorrhage into both the false and the true lumen. Otherwise there have been no early or late mortality or major complications in this series. Even if our experience with endovascular treatment of type B dissections is rather limited, the results so far are promising. Open surgery in many of these cases is complicated with high morbidity and mortality rate and the endovascular technique offers great advantages. A longer follow-up period is necessary to define the place of endovascular treatment.

Aged↗