Risk-Adjusted Outcome Analysis of Endovascular Abdominal Aortic Aneurysm Repair in a Large Population:How Do Stent-Grafts Compare?

Abstract

ࡗ ࡗPurpose: To compare differences in the applicability and incidence of postoperative adverse events among stent-grafts used for repair of infrarenal aortic aneurysms.Methods: An analysis of 6787 patients from the EUROSTAR Registry database was conducted to compare aneurysm morphological features, patient characteristics, and postoperative events for the AneuRx, EVT/Ancure, Excluder, Stentor, Talent, and Zenith devices versus the Vanguard device (control) and each other. Annual incidence rates of complications were determined, and risks were compared using the Cox proportional hazards analysis. Results:The annual incidence rates were: device-related endoleak (types I and III) 6% (range 4%-10%), type II endoleak 5% (range 0.3%-11%), migration 3% (range 0.5%-5%), kinking 2% (range 1%-5%), occlusion 3% (range 1%-5%), rupture 0.5% (range 0%-1%), and all-cause mortality 7% (range 5%-8%). After adjustment for factors influencing outcome, AneuRx, Excluder, Talent, and Zenith devices were associated with a lower risk of migration, kinking, occlusion, and secondary intervention compared to the Vanguard device. Significant increased risk for conversion (EVT/Ancure) and reduced risk of aneurysm rupture (AneuRx and Zenith) and all-cause mortality (Excluder) were found compared to the Vanguard device. Conclusions: Significant differences exist between stent-grafts of different labels in terms of applicability and complications during intermediate to long-term follow-up. Since each stent-graft has its drawbacks, no single label can be identified as the best. It is reassuring that developments in stent-grafts indeed result in better performance than the early stentgrafts. However, a single device incorporating all the perceived improvements should still be pursued. J Endovasc Ther 2005;12:417-429

Twelve-year outcomes after endovascular aneurysm repair using earliest available endograft components from a single center

“…Good results were noted in this era by several different units, and the A-U-I configuration appeared more durable. 14 In this study, open conversion did have a low mortality despite the majority of patients being originally regarded as unfit for open surgery. Similar findings were reported by other early studies.…”

Mid-Term Comparison of Bifurcated Modular Endograft Versus Aorto-Uni-Iliac Endograft in Patients with Abdominal Aortic Aneurysm

“…Although several studies have reported results of EVAR with individual endografts 1-10 and a few have compared different stent grafts, [11][12][13][14][15][16][17][18][19] no comparison between the Talent bifurcated endograft and the Endofit AUI has been published until now. Many surgeons are reluctant to treat AAA with AUI extra-anatomical devices.…”

The influence of smoking on endovascular abdominal aortic aneurysm repair

“…Earlier EUROSTAR studies have chosen this threshold considering growth. [18][19][20][21] To account for relative AAA infrarenal neck changes during follow-up, an increase of Ն15% in transverse aortic neck diameter measured 3 mm distally from the lowermost renal artery was considered significant.…”