Re-interventions after endovascular aortic repair for infrarenal abdominal aneurysms: a retrospective cohort study

Abstract

BackgroundEarly morbidity and mortality are generally lower after endovascular aortic repair (EVAR), than after open repair but re-interventions and late complications are more common. The aim of the present study was to make a detailed description of re-interventions after EVAR-including incidence, indications, procedures, and outcome-with special reference to non-access-related re-interventions.MethodsThis is a retrospective single-center cohort study of re-interventions after standard EVAR with special reference to non-access-related re-interventions. Consecutive patients (n = 405) treated with standard EVAR for non-ruptured (n = 337) or ruptured (n = 68) infrarenal aneurysms between 2005 and 2013 were analysed. Median follow-up was 29 months (range 0–108).ResultsEighty-nine patients (22 %) underwent 113 re-interventions during follow-up. Twenty-seven patients (7 %) had 28 access related re-intervention, 65 patients (16 %) had 85 non-access related reinterventions. Non-access related re-interventions were more common in ruptured aneurysms than in unruptured aneurysms (22 vs. 15 %, p = 0.002). The most frequent indications were endoleak type I (n = 19), type II (n = 21), or type III (n = 5); stent graft migration (n = 9); and thrombosis (n = 14). The most frequent procedures were embolization of endoleak type II (n = 21), additional iliac stent graft (n = 19), proximal extension (n = 12), thrombolysis (n = 8), iliac limb bare-metal stenting (n = 6), and stent graft relining (n = 7). Endovascular technique was used in 83 % of re-interventions.Thirty-day mortality after non-access-related re-interventions was 15 % when initiated from symptoms (rupture or infection) and 0 % when initiated from follow-up findings (p = 0.014). Cumulative survival five years after EVAR was 72 % in patients with a re-intervention and 59 % in patients without (p = 0.21).ConclusionsNon-access-related re-intervention rates are still considerable after EVAR and more frequent after ruptured aneurysms. Endoleak embolization is the most frequent procedure, followed by additional iliac stent grafts. Outcomes after re-interventions are generally good, except when initiated by rupture or infection.

Characterising the incidence and mode of visceral stent failure after fenestrated endovascular aneurysm repair (FEVAR)

“…Half of these complications warranted re-intervention (11% of the overall study population). Given that stent-related complications and their reinterventions after standard EVAR are of similar incidence and are considered the technology’s Achilles’ heel, 8 then visceral stent complications after FEVAR should also be considered significant sequelae. Visceral stent complications can lead to death, either through visceral organ malperfusion or aneurysm rupture after high-pressure endoleak.…”

Early results with the custom-made Fenestrated Anaconda aortic cuff in the treatment of complex abdominal aortic aneurysm

“…33 More research needs to be conducted to prove the feasibility of relining in specific cases. 4,34 Despite great experience in each center with the fenestrated endografts, each center implanted one to five cuffs, and these small numbers per center will result in inexperience with this specific fenestrated cuff. For unknown reasons, 23 clinics did not participate in this study, which could have led to a selection bias.…”

“…3 EVAR has favorable early results over open AAA repair in primary cases but is associated with a higher reintervention rate in the long term because of endoleak, migration, and device failure. [4][5][6][7] A short, conical, and angulated infrarenal aortic neck increases the chance of type IA endoleak and endograft migration. [8][9][10] Subsequently, it may lead to AAA sac expansion and rupture.…”

Open Versus Endovascular Repair of Isolated Iliac Artery Aneurysms

“…32 Rupture was identified as an independent risk factor not only for worse freedom from reintervention in this study but also for EVAR. 33 One of the reasons might be the fact that in patients unfit for OIR, instructions for use (IFU) are often not followed strictly. In these emergency situations, the best fitting and immediately available device is implanted, even if later correction might be needed after stabilization.…”