Risk of reintervention after endovascular aortic aneurysm repair

Abstract

Background:The role of symptomatic presentation in directing reintervention after endovascular aortic aneurysm repair (EVAR) was investigated.Methods: All patients undergoing infrarenal EVAR between 2001 and 2009 were studied. Those needing reintervention were divided into symptomatic and asymptomatic presentations. Kaplan-Meier survival curves were used to calculate freedom from reintervention, and log rank tests for subgroup analyses. Multivariable analysis identified risk factors for reintervention. Results:The study included 553 patients with a mean(s.d.) age of 75(7) years and aneurysm diameter of 65(13) mm. The 30-day mortality rate was 2·5 per cent. Median follow-up was 31 (range 1-97) months. There were 86 reinterventions in 69 (12·5 per cent) of 553 patients; 41 presented with symptoms and 28 were asymptomatic. Reintervention-free survival rates at 1, 3 and 5 years were 90·1, 85·3 and 81·2 per cent. The reintervention rate was higher in patients who needed an intraoperative adjunct during the index procedure (P = 0·014) and in those who did not have intraoperative computed tomography angiography (P = 0·024). Intraoperative adjuncts were an independent risk factor for future reintervention (hazard ratio 2·62, 95 per cent confidence interval 1·18 to 3·76; P = 0·012). Conclusion:Most patients requiring reintervention presented symptomatically. A high-risk subgroup may be identifiable to rationalize a postoperative surveillance programme.

Clinical Outcomes After Crossed-Limb vs. Conventional Endograft Configuration in Endovascular AAA Repair

“…17 In another study of 1768 patients, 18 our patient cohorts were small, our total reintervention rate (7.4%) in the CxL group was lower than that reported in large single center series (12.5% to 19.2%). 18,21 Besides stent-graft design, aortoiliac axis geometry, and the distal landing zone, limb orientation could contribute equally to limb thrombosis. The geometry of the conduit is, in fact, one of the most important determinants of local flow patterns.…”

Aortic rupture and sac expansion after endovascular repair of abdominal aortic aneurysm

“…Previous studies have demonstrated that the under‐lying determinants of aneurysm‐related complications following EVAR are predominantly morphological rather than physiological9–11. In contrast to earlier recommendations12, modern reporting standards for EVAR now stress the need for accurate reporting of aneurysm morphology using images processed on a workstation, permitting three‐dimensional (3D) reconstruction, to place clinical outcomes in context13–15.…”

Transverse minilaparotomy for open abdominal aortic aneurysm repair

“…Despite these two deaths, the morbidity, mortality, hospital stay, and reintervention rates for this cohort compare well with similar figures from large EVAR series. 2,20,21 This unit estimates that once fully operational, the national AAA screening program for England will detect approximately 3000 aneurysms every year in men aged 65. These men will have a projected life expectancy of 21 years 22 at the time of their AAA diagnosis.…”