The Effect of the Diameter of Aneurysm of Abdominal Aorta on Post-operative Leukocytosis in Patients Treated With Endovascular Aneurysm Repair

Abstract

Introduction: The technique of conventional EVAR with a main body and bifurcated limbs has progressed little in the last 10 years. The need for cannulation of the contralateral limb extends procedure times and radiation exposure. The ipsilateral delivery system diameter, plus the time taken for completion of device implantation, often cause limb ischaemia and subsequent patient agitation, leading many to avoid true local anaesthetic EVAR. Reducing the invasiveness of the procedure reduces patient morbidity and increases the opportunity for short stay management. The Altura stent graft is a low-profile (14Fr) dual aortic stent design with 'D' shaped components that are placed back-to-back into the juxta-renal aorta. It has the potential to be simpler to deploy and to reduce radiation exposure, while its low profile could yield benefits in patient morbidity, anaesthesia selection and post-operative management. Methods: The prospective study of consecutive patients treated with the Altura device in single clinical site between 2014 and 2019. Patients underwent clinical and CTA followup at 1 month and then annually after the implantation. Evaluation of CT scans were done by independent radiologist. We report here on initial surgical success and longer term outcomes for these patients. Results: 100 patients (age 71.6 AE 8.7 years) with abdominal aortic aneurysm (AAA) (diameter 57.8 AE 6.7 mm) were treated. Endografts were successfully implanted in all patients (100%).There been no peri-operative deaths within the first 30 days. Mean fluoroscopy time was 24+11 minutes, mean deployment time was 14 minutes (11-54). Eight patients (8%) were treated with distal aorta < 16mm of diameter, 22 (22%) aortic 'D' shaped componentswere placed using offset. Locoregional anaesthesia was used in 91% of cases, with percutaneous access successful in 94% of patients. Cumulative major adverse event rate (MAE: death, stroke, paraplegia, MI, respiratory failure, bowel ischemia and blood loss !1000ml) was 0% at 1 year, 5.7% at 2 years (2/35) with no additional events up to 5 years. Clinical success (freedom from type I/III endoleak or reintervention) was 96% at 30 days (4/100), 100% at one year (58/58), 94.3% at 2 years (2/35). 11 (11%) type II endoleaks were observed. During median follow-up of 28.5 months (3-60), there have been no aneurysm ruptures or AAA-related deaths. Secondary procedures were performed in 11 patients: 3 for type Ia endoleak, one for type Ib endoleak, 2 for iliac stenosis and 5 for type II endoleak. Conclusion: Early and mid-term outcomes to 5 years are very encouraging in this cohort. The potential of the device to reduce implant times and radiation exposure, whilst delivering excellent results, warrants further investigation. Disclosure: Research support from Lombard Ltd.