A systematic review and meta-analysis of long-term reintervention after endovascular abdominal aortic aneurysm repair

Wanken, Zachary J.; Barnes, James H.; Trooboff, Spencer W.; Columbo, Jesse A.; Jella, Tarun K.; Kim, Daniel; Khoshgowari, Arian; Riblet, Natalie; Goodney, Philip P.

doi:10.1016/j.jvs.2020.02.030

Cited by 28 publications

(6 citation statements)

References 64 publications

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“…27 , 28 Newer studies report a 19–33% reintervention rate in the follow-ups for up to fifteen years after EVAR. 29 , 30 , 31 , 32 The results of our study are within the reported range with nearly a quarter of patients needing a secondary procedure. A study on Excluder ® SG with a ten-year follow-up period reported 85% secondary procedure free survival, a result that exceeds ours.…”

Section: Discussionsupporting

confidence: 80%

Single centre experience with Excluder^® stent graft; 17-year outcome

Snoj

Tomazin

Salapura

et al. 2022

Radiology and Oncology

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Background Endovascular abdominal aortic aneurysm repair (EVAR) has become a mainstay of abdominal aorta aneurysm treatment. Long term follow-up on specific stent grafts is needed. Patients and methods This study included 123 patients (104 men; mean age 73.0 years, range 51–89) with abdominal aorta aneurysm, treated with Excluder® stent graft between October 2002 and June 2008. Periprocedural and follow-up data were retrieved by reviewing the records of our institution, while time and cause of death were retrieved from the National Institute of Public Health. If an abdominal aortic aneurysm rupture was listed as the cause of death, records were retrieved from the institution that issued the death certificate. Our primary goal was to assess the primary technical success rate, type 1 and type 2 endoleak, reintervention free survival, 30-day mortality, the overall survival and aneurysm rupture-free survival. Results The median follow-up was 9.7 years (interquartile range, 4.6–13.8). The primary technical success was 98.4% and the 30-day mortality accounted for 0.8%. Secondary procedures were performed in 29 (23.6%) patients during the follow-up period. The one-, five-, ten-, fifteen- and seventeen-year overall survival accounted for 94.3%, 74.0%, 47.2%, 35.8% and 35.8%, while the aneurysm-related survival was 98.4%, 96.3%, 92.6%, 92.6%, 92.6%. In seven (5.7%) patients, abdominal aortic rupture was found as the primary cause of death during follow-up. Conclusions Our data showed that EVAR with Excluder® stent graft offers good long-term results. More than 75% of patients can be treated completely percutaneously. Late ruptures do occur in the first ten years, raising awareness about regular medical controls.

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Section: Discussionsupporting

confidence: 80%

Single centre experience with Excluder^® stent graft; 17-year outcome

Snoj

Tomazin

Salapura

et al. 2022

Radiology and Oncology

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“…A recent study of Wanken et al illustrated that patients who underwent EVAR also remain at risk for secondary interventions indefinitely but this has decreased over time. 30 The rate of 16% secondary interventions corresponds with the long-term outcomes of the EVAR-1 trial, DREAM trial, and OVER trial, 3,10,31 but was slightly higher than the Northern Californian multicenter registry. 32 Intervention rates after EVAR, however, remain high whereas improvements are made in patient identification, 17 surgeon experience 33 , and the durability of endografts.…”

Section: Discussionmentioning

confidence: 86%

Secondary Interventions and Long-term Follow-up after Endovascular Abdominal Aortic Aneurysm Repair

Geraedts

Mulay

Vahl

et al. 2021

Annals of Vascular Surgery

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Background: Early morbidity and mortality are low after endovascular abdominal aneurysm repair (EVAR), but secondary interventions and late complications are common. The aim of the present multicenter cohort study is to detail the frequency and indication for interventions after EVAR and the impact on long-term survival. Methods: A retrospective multicenter cohort study of secondary interventions after elective EVAR for an infrarenal abdominal aortic aneurysm was conducted. Consecutive patients (n ¼ 349) undergoing EVAR between January 2007 and January 2012 were analyzed, with long-term follow-up until December 2018. Those requiring intervention were classified in accordance with the indications and specific nature of the intervention and treatment. The primary study end point was overall survival classified for patients with and without intervention. Kaplan-Meier analysis was used to estimate overall survival for those who did and who did not undergo secondary interventions. Univariable and multivariable Cox regression were performed to identify independent variables associated with mortality. Results: Some 56 patients (16%) underwent 72 secondary interventions after EVAR during a median (interquartile range) follow-up period of 53.2 months (60.1). Some 45 patients (80.4%) underwent one intervention. Indications for intervention included mainly endograft kinking/outflow obstruction and type II endoleak. An endovascular technique was used in 40.3% of interventions. Median time to secondary intervention was 24.1 months. In 93 patients with abnormalities on imaging, no intervention was performed mainly because the abnormality had disappeared on follow-up imaging (43%). Kaplan-Meier curves showed no difference in survival for patients with and without secondary interventions (P ¼ 0.153). Age (hazard ratio [HR]: 1.089, 95% confidence interval [CI]: 1.063e1.116), ASA classification (ASA III, IV HR: 1.517, 95% CI: 1.056e2.178) were significantly related to mortality. Conclusions: Secondary intervention rates are still considerable after EVAR. Endograft kinking/outflow obstruction and endoleak type II are the most common indications for a secondary intervention. Secondary interventions did not adversely affect long-term overall survival after EVAR.

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“…A systematic review of EVAR for AAA by Wanken et al revealed that 14% of patients that had been treated by EVAR using newer devices needed the reintervention even 7 years after EVAR. 10) In our case, when any type of the endoleak occurs, the increase of the inner pressure of AAA can affect IMAA. EVAR can be one of the options to treat IMAA; however, a long-term follow-up is mandatory to examine IMAA reexpansion.…”

Section: Discussionmentioning

confidence: 76%

A Case of Thrombosed Inferior Mesenteric Artery Aneurysm Concomitant with Abdominal Aortic Aneurysm Treated by Endovascular Aneurysm Repair

Yamashita

Nakagawa

Sakamoto

et al. 2021

Annals of Vascular Diseases

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A 71-year-old man was referred to our hospital under a diagnosis of abdominal aortic aneurysm (AAA). The past history of the patient included a sigmoid colectomy at 64 years old for an ischemic colitis. The maximum diameter of AAA was still 45 mm, and the inferior mesenteric artery (IMA) was aneurysmal and was 30 mm in diameter and thrombosed. The growth rate in the diameter of IMA aneurysm was 5 mm per year for the last 3 years. The patient successfully underwent endovascular aneurysm repair (EVAR), and the postoperative course was good. At 5 years after EVAR, computed tomography revealed a decrease in the diameter of both aneurysms.

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A systematic review and meta-analysis of long-term reintervention after endovascular abdominal aortic aneurysm repair

Cited by 28 publications

References 64 publications

Single centre experience with Excluder^® stent graft; 17-year outcome

Single centre experience with Excluder^® stent graft; 17-year outcome

Secondary Interventions and Long-term Follow-up after Endovascular Abdominal Aortic Aneurysm Repair

A Case of Thrombosed Inferior Mesenteric Artery Aneurysm Concomitant with Abdominal Aortic Aneurysm Treated by Endovascular Aneurysm Repair

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A systematic review and meta-analysis of long-term reintervention after endovascular abdominal aortic aneurysm repair

Cited by 28 publications

References 64 publications

Single centre experience with Excluder® stent graft; 17-year outcome

Single centre experience with Excluder® stent graft; 17-year outcome

Secondary Interventions and Long-term Follow-up after Endovascular Abdominal Aortic Aneurysm Repair

A Case of Thrombosed Inferior Mesenteric Artery Aneurysm Concomitant with Abdominal Aortic Aneurysm Treated by Endovascular Aneurysm Repair

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Single centre experience with Excluder^® stent graft; 17-year outcome

Single centre experience with Excluder^® stent graft; 17-year outcome