Comparison of midterm results of endovascular aneurysm repair for ruptured and elective abdominal aortic aneurysms

Abstract

Objective: Endovascular aneurysm repair (EVAR) became an increasingly preferred modality for abdominal aortic aneurysm (AAA) repair both in elective AAA repair (el-EVAR) and EVAR of a ruptured AAA (r-EVAR) setting. Ruptured AAAs usually have more hostile anatomies and less time for planning. Consequently, more complications may arise after r-EVAR. The purpose of this study was to compare mi-term outcomes between r-EVAR and el-EVAR.Methods: A retrospective cohort analysis of patients undergoing EVAR from 2000 to 2015 at a tertiary institution was performed. Patients with previous aortic surgery, nonatherosclerotic AAA and isolated iliac aneurysms were excluded. In-hospital casualties or patients who were intraoperatively converted to open repair were also excluded. For the midterm outcome analysis, only patients with at least two postoperative examinations (a 30-day computed tomography scan and a second postoperative examination performed 6 months or later) were considered. The primary end point was freedom from aneurysm-related complications (a composite of type I or III endoleak, aneurysm sac growth, migration of more than 5 mm, device integrity failure, AAA-related death, late postimplant rupture, or AAA-related secondary intervention). Freedom from secondary interventions, neck-related events (defined as a composite of type IA endoleak, migration of more than 5 mm, or preemptive neck-related secondary intervention) and late survival were secondary end points. The impact of device instructions for use (IFU) compliance on neck events was also assessed. Results:The study included 565 patients (65 r-EVAR and 500 el-EVAR). Eighty-two patients were treated outside proximal neck IFU, 13 in the r-EVAR group (21.3%) and 69 (14.5%) in the el-EVAR (P ¼ .16). During the index hospitalization, there were more complications (12.3% vs 3.2%; P ¼ .001) and reinterventions (12.3% vs 2.8%; P < .001) in the r-EVAR group. After discharge, median clinical follow-up time was 4.3 years (interquartile range, 2.1-7.0 years) without differences between both groups. Five-year freedom from AAA-related complications was 53.9% in the r-EVAR group and 65.4% in the el-EVAR (P ¼ .21). In multivariable analysis the r-EVAR group was not at increased risk for late complications (hazard ratio

A novel technique for the treatment of a ruptured para-anastomotic thoracic aortic aneurysm in the presence of a chronic abdominal aortic dissection

“…The safety and efficacy of endovascular aneurysm repair (EVAR) for ruptured thoracic and abdominal aortic aneurysms (AAAs) have been evidenced in many studies. 13,14 Device configurations typically used in these situations consist of bifurcated, tube grafts or aorto-uniiliac endografts. 14 These devices, however, may not be applicable in unfavorable anatomy such as large diameter sealing zones, tortuous access vessels or the presence of dissections.…”

“…13,14 Device configurations typically used in these situations consist of bifurcated, tube grafts or aorto-uniiliac endografts. 14 These devices, however, may not be applicable in unfavorable anatomy such as large diameter sealing zones, tortuous access vessels or the presence of dissections. In the present case, EVAR with standard devices was not possible due to the presence of a coexisting aortic dissection.…”

Aneurysm Volumes After Endovascular Repair of Ruptured vs Intact Aortic Aneurysms: A Retrospective Observational Study

“…Even though the authors did not assess reinterventions or secondary interventions in the current study, a previous paper reported a greater but not significantly increased need for reinterventions in the rEVAR group. 10…”

“…Even though the authors did not assess reinterventions or secondary interventions in the current study, a previous paper reported a greater but not significantly increased need for reinterventions in the rEVAR group. 10 Aneurysm sac changes following repair are intimately related to patient outcomes, mainly in the elective setting. 12 In our population, patients with >10% sac shrinkage during the first postoperative year had a lower risk of developing future aneurysm-related complications compared to patients with stable or enlarging aneurysm sacs.…”

“…5,6 Landmark reports have shown greater need for reinterventions after EVAR over open repair for rAAA. [7][8][9] Specifically, a post hoc analysis of secondary interventions from the IMPROVE trial 7 and 2 observational studies 10,11 have shown a greater risk of secondary interventions after rEVAR compared with iEVAR, which may relate to higher anatomical complexity of rAAA, absence of optimal emergency imaging, shorter planning time, and limited stock. Consequently, a tighter follow-up strategy may be anticipated for rEVAR patients.…”