The Outcome of Endovascular Repair of Small Abdominal Aortic Aneurysms

Golledge, Jonathan; Parr, Adam; Boult, Margaret; Maddern, Guy J.; Fitridge, Robert

doi:10.1097/01.sla.0000253965.95368.52

Cited by 24 publications

(19 citation statements)

References 29 publications

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“…These rates are very similar to an estimated 74.6% of patients free from any endoleak through to five years and 93.2% free from type I endoleaks in a contemporary Australian cohort. 36 In the ENGAGE study, 89.4% of patients with follow up imaging had declining or stable (61.4% declining, 28.0% stable) sac diameters at five years. This percentage is comparable to early generation results, where 91% of patients had declining or stable (49% declining, 43% stable) sac diameters.…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Five Year Outcomes of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair in the ENGAGE Registry

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Power

Böckler

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Analysis of the performance of modern stent grafts is necessary as earlier generation stent grafts are associated with an increased need for secondary interventions. Five year follow up of patients treated with the Endurant stent graft in the ENGAGE registry demonstrates better survival and lower rates of endoleaks, stent migration, and re-intervention. Longer term follow up to 10 years will be necessary to compare fully the advantages of endovascular aneurysm repair against open repair. However, these mid-term results show the Endurant stent graft was successful in treating a large cohort of patients with a wide range of anatomies. Objective/background: Endovascular abdominal aortic aneurysm repair (EVAR) is commonly used to treat abdominal aortic aneurysm (AAA). However, the incidence of long-term complications and the need for reinterventions after EVAR remain a concern. Newer generation stent grafts have encouraging short and midterm outcomes, but thorough analysis of their long-term performance is necessary. Methods: The ENGAGE registry includes a total of 1263 patients with AAA enrolled from March 2009 to April 2011 at 79 centres across 30 countries. The aim of this study is to present standard EVAR outcomes in the registry after five years. Results: A significant proportion of the ENGAGE patients presented with challenging features, such as 15.2% with an AAA diameter >7 cm, 12.0% with proximal neck lengths <15 mm, and 10.2% with infrarenal neck angles >60. Of the 1263 enrolled subjects, 17.8% were implanted outside of the instructions for use for the device. At the five year follow up, the KaplaneMeier overall survival rate was 67.4% and the freedom from aneurysm related mortality was 97.8%. Freedom from aneurysm rupture, secondary procedures, and conversion to open repair at five years were 98.6%, 84.3%, and 97.9% respectively. The five year freedom from type IA endoleaks was 95.2% and for type III endoleaks 97.4%. Aneurysm sac diameter at five years was observed to have either decreased !5 mm in diameter or remained stable in 89.4% of the patients. Conclusion: Five year follow up of patients in the ENGAGE registry demonstrates sustained safety, effectiveness, and durability in an international cohort that is reflective of real world experience. Additional follow up is expected through to 10 years.

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Section: Discussionmentioning

confidence: 99%

Editor's Choice – Five Year Outcomes of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair in the ENGAGE Registry

Teijink

Power

Böckler

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…A presentation at a recent meeting of the European Society of Vascular Surgery reported that at 3 years, early elective EVAR did not reduce mortality for patients with 40–54mm AAAs 114. Longer term results are awaited 115,116. Recently, it has been suggested that delaying surgery does not alter the anatomical suitability for EVAR 117.…”

Section: 0 Current Diagnosis Of Aaamentioning

confidence: 99%

Diagnosis and Monitoring of Abdominal Aortic Aneurysm: Current Status and Future Prospects

Moxon

Parr²,

Emeto³

et al. 2010

Current Problems in Cardiology

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148

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Abdominal aortic aneurysm (AAA) remains an important cause of morbidity and mortality in elderly men, and prevalence is predicted to increase in parallel with a global ageing population. AAA is commonly asymptomatic, and in the absence of routine screening, diagnosis is usually incidental when imaging to assess unrelated medical complaints. In the absence of approved diagnostic and prognostic markers, AAAs are monitored conservatively via medical imaging until aortic diameter approaches 50-55mm and surgical repair is performed. There is currently significant interest in identifying molecular markers of diagnostic and prognostic value for AAA. Here we outline the current guidelines for AAA management, and discuss modern scientific techniques currently employed to identify improved diagnostic and prognostic markers. KeywordsAbdominal aortic aneurysm; diagnosis; prognosis; biomarker INTRODUCTIONAn abdominal aortic aneurysm (AAA) is a dilation of the infra-renal aorta, which appears to result from chronic weakening of the arterial wall, increasing the risk of fatal rupture.1 -3 AAA is also associated with an increased risk of other major cardiovascular events in aneurysmal patients. For example the UK small aneurysm trial (UKSAT), demonstrated that only 16% of deaths in patients with 40-55mm AAAs was related to AAA repair or rupture while ~50% were due to other cardiovascular causes (mainly myocardial infarction and stroke).4 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access AAA pathologyMacroscopically, an AAA can be considered a dilatation of the infrarenal aorta, giving rise to a permanent vessel diameter >30mm (typical abdominal aortic diameter ranges from 15 to 25mm). 23-27 AAA vessel dilation is commonly progressive, and is often accompanied by the formation of a laminated, non-occlusive, intraluminal thrombus.28 -29 Thrombus size and location varies between patients, and the arterial wall may be partially or completely covered by the thrombus ( Figure 1A and B). 30 The thrombus remains in permanent contact with circulating blood and is continually remodeled, 31,32 and thrombus size increases in parallel with aortic dilation. Due to constant remodeling the thrombus is a laminated structure comprising a red blood cell-rich luminal layer in contact with the flowing blood, progressing to a brown fibrinolysed layer at the aortic wall. 29 Localised hypoxia has been demonstrated in regions of the aorta covered by the thrombus and this has been suggested to contribute to physiological stresses within the arterial wall. 33 Similar to other vascular dise...

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“…The Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP‐S) is the only health technology assessment group in the world that focuses on surgical procedures. During the 10 years since its inception, this group has developed a strong international profile through the production of more than 60 reports on evidence‐based surgery 1–62 , surgical technologies and audit. In addition ASERNIP‐S has pioneered the introduction of national audits into the surgical community.…”

Section: Overviewmentioning

confidence: 99%

Asernip‐s: International Trend Setting

Maddern

Boult

Ahern

et al. 2008

ANZ Journal of Surgery

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The Australian Safety and Efficacy Register of New Interventional Procedures--Surgical (ASERNIP-S) came into being 10 years ago to provide health technology assessments specifically tailored towards new surgical techniques and technologies. It was and remains the only organisation in the world to focus on this area of research. Most funding has been provided by the Australian Government Department of Health, and assessments have helped inform the introduction of new surgical techniques into Australia. ASERNIP-S is a project of the Royal Australasian College of Surgeons. The ASERNIP-S program employs a diverse range of methods including systematic reviews, technology overviews, assessments of new and emerging surgical technologies identified by horizon scanning, and audit. Support and guidance for the program is provided by Fellows of the Royal Australasian College of Surgeons. ASERNIP-S works closely with consumers to produce health technology assessments and audits, as well as consumer information to keep patients fully informed of research. Since its inception, the ASERNIP-S program has developed a strong international profile through the production of over 60 reports on evidence-based surgery, surgical technologies and audit. The work undertaken by ASERNIP-S has evolved from assessments of the safety and efficacy of procedures to include guidance on policies and surgical training programs. ASERNIP-S needs to secure funding so that it can continue to play an integral role in the improvement of quality of care both in Australia and internationally.

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The Outcome of Endovascular Repair of Small Abdominal Aortic Aneurysms

Abstract: EVAR can be carried with good perioperative outcome in patients with small AAA; however, intermediate success is hampered by the need for reintervention and continued aortic sac enlargement. At present, widespread treatment of small AAAs by EVAR would appear inappropriate.

Cited by 24 publications

References 29 publications

Editor's Choice – Five Year Outcomes of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair in the ENGAGE Registry

Editor's Choice – Five Year Outcomes of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair in the ENGAGE Registry

Diagnosis and Monitoring of Abdominal Aortic Aneurysm: Current Status and Future Prospects

Asernip‐s: International Trend Setting

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