Comparison of outcomes following endovascular repair of abdominal aortic aneurysms based on size threshold

Objective: Type III endoleaks (T-III) following endovascular repair of aortic aneurysms (EVAR) remain a major concern. Our center experienced a recent concentration of T-III endoleaks requiring elective and emergency treatment and prompted our review of all EVAR implants over a 40 month period from April 2011 until August 2014. This report represents a single center experience with T-III endoleak management with analysis of factors leading to the T-III related failure of EVAR. Methods:A retrospective review of all the operative reports, medical records and computed tomography scans were reviewed from practice surveillance. Using SVS aneurysm reporting standards, we analyzed the morphology of the aneurysms before and after EVAR implant using computed tomography (CT). Index procedure and frequency of reinterventions required to maintain aneurysm freedom from rupture were compared across all devices using SAS version 9.4 (SAS Institute, Inc. Cary, NC.). . Major adverse events requiring secondary interventions for aneurysm treatment beyond primary implant were analyzed for methods of failure.Aneurysm morphology of patients requiring EVAR was compared across all endograft devices used for repair. For purposes of major adverse event analysis, patients receiving Endologix (ELX) endograft were combined into Group 1 and Gore, Cook and Medtronic endograft patients were placed into Group 2. Results:Overall technical success and discharge survival was achieved in 97.3% and 98% of patients regardless of device usage. There was no significant device related difference identified between patient survival or freedom from intervention. Major adverse events involving aneurysm treatment were over 7 fold more frequent with ELX (Group1) vs non-ELX (Group 2) endografts (p<0.01). Group 1 patients with aneurysm diameters larger than 65 mm were associated with a highly significant value for development of a T-III endoleak (OR=11.16, 95% CI (2.17, 57.27); p=0.0038). Conclusions:While EVAR technical success and survival was similar across all devices, ELX devices exhibited an unusually high incidence of Type III endoleaks when implanted in AAA with a diameter of more than 65 mm. Frequent reinterventions were required for Endologix devices for prevention of aneurysm rupture due to T-III endoleaks.

Section: Resultssupporting

confidence: 90%

Failure mode analysis of the Endologix endograft

Lemmon

Motaganahalli

Chang

et al. 2016

“…These results are similar to those we reported earlier 3,4 or those published of the National Inpatient Sample database 2 or reported by others. 11,28,[32][33][34] The low overall early mortality was likely the reason we did not find differences in our subgroups. Factors associated with early mortality in our study included only advanced age and high surgical risk, similar to factors observed in earlier studies.…”

Section: Discussionmentioning

confidence: 74%

Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms

Huang

Gloviczki

Duncan

et al. 2017

Maximal aortic diameter is associated with long-term outcomes after elective EVAR. Patients with large AAAs (≥6.0 cm) have higher all-cause mortality, complication, and reintervention rates after EVAR than those with smaller aneurysms. We continue to recommend that AAAs be repaired when they reach 5.5 cm as recommended by the guidelines of the Society for Vascular Surgery. On the basis of our data, EVAR should be considered even in high-risk patients with a maximal aortic diameter between 5.5 and 6.0 cm because surgical risk with aneurysm size above 6.0 cm will increase significantly.

“…[12][13][14][15] The most serious consequence of type III endoleaks is repeat exposure of the aneurysm sac to direct arterial blood pressure with subsequent aneurysm sac enlargement and death from AAA rupture. Additionally, it has now been recognized that endograft uncoupling can obstruct aortic blood flow resulting in AAA thrombosis and lower extremity ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…The 2.4% incidence of type IIIa endoleaks reported here is comparable to that of recent studies using Endologix and other modular endografts, which found a 2% to 2.7% long-term incidence of type III endoleaks across multiple endograft platforms. 14,17 In a recent detailed analysis of 108 patients treated with Endologix AFX endograft, Welborn et al 18 reported a 2.3% incidence of type IIIa endoleaks. In addition, independent core laboratory data extracted from two recently presented, but as yet unpublished studies, of the Endologix AFX system by Motaganahalli et al and Arthurs et al found four type IIIa endoleaks in 127 combined patients (3.1%) monitored an average of 10 months after elective EVAR.…”

Section: Discussionmentioning

confidence: 99%

Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms

Skibba

Evans

Greenfield

et al. 2015

Although a small number of secondary interventions were needed after EVAR with the Endologix Powerlink or AFX endografts, most were undertaken for late main-body component uncoupling and type IIIa endoleak, which can occur after sideways displacement of the endograft in large and angulated AAAs. Patients treated before 2013 under the old instructions for use should be evaluated for signs of impending component separation and monitored annually, noting that expected indicators of endograft failure, such as increasing AAA diameter and endoleak, may be absent.