Endovascular repair of infrarenal aortic aneurysms with the first- and second-generation devices that predominated in this study was associated with a risk of late failure, according to an analysis of observed hard end points of 3% per year. Action taken to address the risk factors identified by the study may improve results in the future.

phology. One of the remaining concerns is uncertainty about the long-term effect of persistent blood flow within the aneurysm sac after endovascular grafting, an occurrence known as endoleak. 1 In fact, endoleak development constitutes one of the prime reasons to perform postoperative surveillance by regularly performed image studies, usually computed tomography (CT) scanning. [2][3][4] The main purpose of EAR is to prevent death from rupture of the aneurysm, and early identification of endoleaks is intended to help obtain this goal. Protocols for when and how to manage endoleaks have been suggested, despite conflicting opinions on the natural history of endoleaks. 5 Several investigators consider the presence of perigraft flow to be evidence of failed treatment because it may predict aneurysmal enlargement and eventual rupture. 6-8 A contrasting opinion was presented in a recent study in which no relation between early endoleaks and late rupture, conversion to open surgery, and death could be demonstrated. 9 From this latter report, it might be concluded that the observation of perigraft flow had little consequence for the ultimate fate of the patient.Clinical management of endoleak may differ between types of endoleak. A generally accepted classification dis-Although the durability of endovascular repair of abdominal aortic aneurysms (AAAs) (EAR) is not definitively established, this treatment method is increasing in popularity among patients and doctors. Physicians from different vascular-oriented disciplines have engaged in workshops and training sessions to learn how to perform the technique in patients with suitable aneurysm mor-461 Objective: The purpose of this study was to assess the incidence, risk factors, and consequences of endoleaks after endovascular repair of abdominal aortic aneurysm. Methods: Data on 2463 patients were collected from 87 European centers and recorded in a central database. Preoperative data were compared for patients with collateral retrograde perfusion (type II) endoleak (group A), patients with devicerelated (type I and III) endoleaks (group B), and patients in whom no endoleak was detected (group C). Only endoleaks observed after the first postoperative month of follow-up were taken into consideration. Regression analysis was performed to investigate statistical relationships between the occurrence and type of endoleak and preoperative patient and morphologic characteristics, operative details, type of device, and experience of the operating team. In addition, postoperative changes in aneurysmal morphology, the need for secondary interventions, conversions to open repair, aneurysmal rupture, and mortality during follow-up were compared between these study groups. Results: Patients in group A had a higher prevalence of a patent inferior mesenteric artery compared with patients without endoleak. Patients in group B were treated more frequently than patients in group C by an operating team with experience of less than 30 procedures. The mean follow-up period was 15.4 months. Seco...

The midterm outcome of large aneurysms after EVAR was associated with increased rates of aneurysm-related death, unrelated death, and rupture. Reports of EVAR should stratify their outcomes according to the diameter of the aneurysm. Large aneurysms need a more rigorous post-EVAR surveillance schedule than do smaller aneurysms. In small aneurysms EVAR was associated with excellent outcome. This finding may justify reappraisal of currently accepted management strategies.

e-EVAR was a feasible treatment in the majority of patients with rAAA and snrAAA. Blood loss and the requirements of fluid transfusion were significantly decreased. Most importantly in this institutional series significantly lower first-month mortality was observed in the group with preferential e-EVAR compared to a control group. A multi-center study assessing the outcome of preferential use of e-EVAR in patients with acute symptomatic AAA is required.

In myelodysplastic syndromes (MDS), health-related quality of life (HRQoL) represents a relevant patient-reported outcome, which is essential in individualized therapy planning. Prospective data on HRQoL in lower-risk MDS remain rare. We assessed HRQOL by EQ-5D questionnaire at initial diagnosis in 1690 consecutive IPSS-Low/Int-1 MDS patients from the European LeukemiaNet Registry. Impairments were compared with age- and sex-matched EuroQol Group norms. A significant proportion of MDS patients reported moderate/severe problems in the dimensions pain/discomfort (49.5%), mobility (41.0%), anxiety/depression (37.9%), and usual activities (36.1%). Limitations in mobility, self-care, usual activities, pain/discomfort, and EQ-VAS were significantly more frequent in the old, in females, and in those with high co-morbidity burden, low haemoglobin levels, or red blood cells transfusion need (p < 0.001). In comparison to age- and sex-matched peers, the proportion of problems in usual activities and anxiety/depression was significantly higher in MDS patients (p < 0.001). MDS-related restrictions in the dimension mobility were most prominent in males, and in older people (p < 0.001); in anxiety/depression in females and in younger people (p < 0.001); and in EQ-VAS in women and in persons older than 75 years (p < 0.05). Patients newly diagnosed with IPSS lower-risk MDS experience a pronounced reduction in HRQoL and a clustering of restrictions in distinct dimensions of HRQoL as compared with reference populations.