with open repair; however, concerns about long-term durability remain. This analysis evaluated the incidence of secondary interventions (SI) after TEVAR and determined functional outcomes and survival.Methods: A retrospective review was completed of all TEVAR patients from 2004 to 2011. Patients with SI were further analyzed. A validated questionnaire (Eastern Cooperative Oncology Group score) was used to assess ability to perform activities of daily living. Kaplan-Meier analysis was used to estimate survival.Results: Of 587 patients, 78 (13%) required SI at median Ϯ standard deviation of 4.7 months (11.5 Ϯ 16.5, Fig 1). Seventeen (22%) underwent multiple SI. Forty (6.8%) initially underwent endovascular revision, with six (15%) requiring subsequent open reintervention. Thirty-eight (6.5%) initially had open revision, with six (16%) requiring subsequent endovascular remediation. Median time to endovascular SI was 7.6 months (16.0 Ϯ 18.8), which was significantly longer than time to open SI (1.9; 6.9 Ϯ 12.3 months; P ϭ .01). SI incidence differed significantly amongst various indications (P ϭ .005): acute dissection (24.7%), chronic dissection (16.5%), degenerative aneurysm (14.1%), traumatic transection (8.3%), penetrating ulcer (1.5%), and other miscellaneous (thoracoabdominal aneurysms, mycotic aneurysms, pseudoaneurysms, 17.8%. Most common indications for SI after acute/chronic dissection were persistent false lumen perfusion and/or proximal/distal extension of disease, whereas for degenerative aneurysms, SI was performed primarily to treat type I/III endoleaks. SI patients had more comorbidities (P Ͻ .0001) and greater number of postoperative complications after the index TEVAR (P Ͻ .0001) compared with those without SI. No survival difference was noted between the groups (SI vs No SI; P ϭ .93; Fig 2). At median follow-up of 20.4 months (range, 6-52 months), functional status was significantly better among patients first treated with endovascular SI compared with open revision (Eastern Cooperative Oncology Group scale: 1.7 Ϯ 2.1 vs 2.7 Ϯ 2.1; P ϭ .04).Conclusions: SI after TEVAR is common, particularly amongst patients treated for acute dissection, which underscores the need for vigilant surveillance. Although significant functional impairment is noted after SI for TEVAR, patients can be successfully treated with open and endovascular techniques with no significant increase in long-term mortality.

AA men with symptomatic PAD were found to have lower LS rates than CAUs. However, this was likely due to presenting with advanced ischemia or with poor prognostic factors that are independently associated with limb loss.

Ambulatory PEVAR was found to be feasible and safe in one-third of patients undergoing elective EVAR who did not have excessive medical risk, had good functional capacity, and underwent an uneventful procedure. The impact of SDD on cost-effectiveness needs to be further assessed and may not be feasible in hospitals reimbursed based on admission status.

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