Long-term outcomes of infrarenal endovascular aneurysm repair with a commercially available stent graft

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T1 - Long-term outcomes of infrarenal endovascular aneurysm repair with a commercially available stent graft

AU - Abdulrasak, Mohammed

AU - Sonesson, Björn

AU - Singh, Bharti

AU - Resch, Timothy

AU - Dias, Nuno V.

PY - 2019

Y1 - 2019

N2 - Objective: To assess the long-term results of elective abdominal aortic aneurysm (AAA) repair with a single stent graft system. Methods: Patients undergoing elective, infrarenal endovascular aneurysm repair (EVAR) with a single-stent graft system between 1998 and 2012 were analyzed retrospectively registering pre-, intra-, and postoperative data. All imaging was reviewed. Data are presented as median and interquartile range unless otherwise stated. Results: A total of 543 patients were included (476 males; 74 [69-79] years). Technical success was achieved in 522 (96.1%) patients. Eight (1.5%) patients died perioperatively. Median imaging follow-up was 5.0 (2.8-8.0) years. Freedom from reinterventions was 72 ± 3% at 10 years. Primary and secondary clinical success rates were 58 ± 3% and 78 ± 2% at 10 years, respectively. Freedom from late AAA-related death was 96 ± 1% and overall survival was 32 ± 2% at 10 years. Late persistent secondary clinical failure occurred in 77 (14.2%) patients. Most of the patients with late failures did not undergo reinterventions (83.1%) because they were unfit (39 patients), refused (5 patients), or had stable mild findings (20 patients). Five patients were converted to open repair (most recent, 2008). Favorable neck anatomy was more common in the second half of the study and was associated with less proximal intraoperative adjuncts. Importantly, it also conferred higher primary and secondary clinical success (P = .001 and P < .0001) and primary and assisted freedom from type I/III endoleaks (P = .002 and P < .0001); along with lower AAA-related mortality rates (P = .008). Conclusions: Elective infrarenal EVAR of asymptomatic AAA with single-stent graft has sustainable long-term results, especially when the aneurysm neck anatomy is favorable. AAA-related death and conversion to open repair are very rare events, but the overall survival after 10 years is quite low. The majority of the patients with persistent failure were unfit or refused further reinterventions or had stable findings. Good patient selection and technical developments may continue to improve the results in the future.

AB - Objective: To assess the long-term results of elective abdominal aortic aneurysm (AAA) repair with a single stent graft system. Methods: Patients undergoing elective, infrarenal endovascular aneurysm repair (EVAR) with a single-stent graft system between 1998 and 2012 were analyzed retrospectively registering pre-, intra-, and postoperative data. All imaging was reviewed. Data are presented as median and interquartile range unless otherwise stated. Results: A total of 543 patients were included (476 males; 74 [69-79] years). Technical success was achieved in 522 (96.1%) patients. Eight (1.5%) patients died perioperatively. Median imaging follow-up was 5.0 (2.8-8.0) years. Freedom from reinterventions was 72 ± 3% at 10 years. Primary and secondary clinical success rates were 58 ± 3% and 78 ± 2% at 10 years, respectively. Freedom from late AAA-related death was 96 ± 1% and overall survival was 32 ± 2% at 10 years. Late persistent secondary clinical failure occurred in 77 (14.2%) patients. Most of the patients with late failures did not undergo reinterventions (83.1%) because they were unfit (39 patients), refused (5 patients), or had stable mild findings (20 patients). Five patients were converted to open repair (most recent, 2008). Favorable neck anatomy was more common in the second half of the study and was associated with less proximal intraoperative adjuncts. Importantly, it also conferred higher primary and secondary clinical success (P = .001 and P < .0001) and primary and assisted freedom from type I/III endoleaks (P = .002 and P < .0001); along with lower AAA-related mortality rates (P = .008). Conclusions: Elective infrarenal EVAR of asymptomatic AAA with single-stent graft has sustainable long-term results, especially when the aneurysm neck anatomy is favorable. AAA-related death and conversion to open repair are very rare events, but the overall survival after 10 years is quite low. The majority of the patients with persistent failure were unfit or refused further reinterventions or had stable findings. Good patient selection and technical developments may continue to improve the results in the future.

KW - Abdominal aortic aneurysm

KW - Endovascular aortic repair

KW - Stent graft

U2 - 10.1016/j.jvs.2019.09.061

DO - 10.1016/j.jvs.2019.09.061

M3 - Article

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 1097-6809

ER -