The impact of stent-graft development on outcome of AAA repair--a 7-year experience

OBJECTIVE: to analyse the impact of stent-graft (SG) design and operator skill on the outcome of endovascular AAA repair. DESIGN: prospective non-randomised open. MATERIAL: a total of 158 patients (mean age 71) underwent SG repair. Patients were treated with five different types of SG: first (n =58) and second ( n =17) generation Ivancev-Malmo monoiliac SG (IM I and IM II respectively) combined with femoral-femoral crossover, Chuter bifurcated SG (n =15), Vanguard SG ( n =15) and the Zenith SG ( n =53). METHODS: patients underwent DSA and contrast CT preoperatively and were then followed with CT and digital scans. Recently, one change in AAA diameter and endoleaks (EL) were recorded. Mortality, complications and secondary interventions were recorded and life-table analysis for intervention-free SG survival calculated. RESULTS: immediate and late conversions as well as 30-day mortality were reduced for 2nd (Zenith and Vanguard) compared to 1st generation SG (IM I, Im II and chuter). SG migrations occurred only with the IM I and Chuter SG. Type I EL were significantly more common in 1st generation SG. First generation SG required significantly more secondary interventions than 2nd SG up to 20 months post-operatively. The number of unplanned intraoperative adjunctive manoeuvres was increased with 2nd SG. CONCLUSIONS: enhanced SG design has improved the probability of SG success after endovascular AAA repair. Better technical skills may also have contributed to improved results.