Outcome of symptomatic, unruptured abdominal aortic aneurysms after endovascular repair with the Zenith stent-graft system

Nevala, Terhi; Perälä, Jukka; Aho, Pekka; Matsi, Pekka J.; Ylönen, Kari; Roth, Wolf-Dieter; Manninen, Hannu; Mäkinen, Kimmo; Lepäntalo, Mauri; Biancari, Fausto

doi:10.1080/14017430701819105

Cited by 10 publications

(18 citation statements)

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“…3–5,10,13,14,18 Our incidence is near the low end of the reported spectrum, similar to the 2008 report of Nevala et al 2 who reported a 6% frequency of Sx-AAA. It is unclear if these more contemporary cohorts have a lower frequency of Sx-AAAs based on increased surveillance or elective repair, or if this is related to other, unknown factors.…”

Section: Discussionsupporting

confidence: 88%

“…Such AAAs are termed symptomatic and represent 5.5% to 22% of all AAAs that require operation in previously reported surgical series. 2–8 …”

mentioning

confidence: 99%

“…2–4,9–14 Additionally, major adverse event (MAE) rates after Sx-AAA repair have been found to be much higher than after E-AAA repair. 4,5,7,14,15 Although most of the reported experience concerns open repair of Sx-AAAs, more recent series have described successful endovascular aneurysm repair (EVAR).…”

mentioning

confidence: 99%

“…4,5,7,14,15 Although most of the reported experience concerns open repair of Sx-AAAs, more recent series have described successful endovascular aneurysm repair (EVAR). 2,6 However, these are small series of patients treated by EVAR, without direct comparison to open repair.…”

mentioning

confidence: 99%

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Outcomes of symptomatic abdominal aortic aneurysm repair

Martino

Nolan

Goodney

et al. 2010

Journal of Vascular Surgery

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Objective Operative mortality of patients undergoing symptomatic abdominal aortic aneurysm (Sx-AAA) repair has been reported at 6% to 30% during the past 25 years. We used a multicenter regional database to describe the contemporary outcomes of patients undergoing repair of Sx-AAA. Methods All patients undergoing infrarenal AAA repair in 11 hospitals comprising the Vascular Study Group of Northern New England (VSGNNE) between 2003 and 2009 were studied. Sx-AAA was prospectively defined as an AAA accompanied by abdominal or back pain or tenderness, but without rupture. The primary study end point was in-hospital mortality. Secondary end points included in-hospital postoperative major adverse events (MAE) and late survival. These outcomes were compared between symptomatic patients and contemporary VSGNNE cohorts of elective (E-AAA) and ruptured AAAs (R-AAAs) treated within the same study period. Results During the study period, 2386 AAA repairs were performed, comprising 1959 (82%) E-AAAs, 156 (7%) Sx-AAAs, and 271 (11%) R-AAAs. Repair was endovascular in 945 (48%) E-AAAs, 60 (38%) Sx-AAAs, and 33 (12%) R-AAAs. Hospital mortality was 1.7% for E-AAA repair and 1.3% for Sx-AAA repair, but was 34.7% for R-AAA repair (P < .001). The MAE rates were 20%, 35%, and 63%, respectively, for E-AAA, Sx-AAA, and R-AAA repairs (P < .001). The mean Glasgow Aneurysm Score (GAS) for Sx-AAA patients who survived was 79 ± 12. Those who died had an average score of 92 ± 7, and 83% of all Sx-AAA and R-AAA patients who died had a GAS >85. Kaplan-Meier analysis demonstrated that at 1 and 4 years, Sx-AAA repair was associated with intermediate survival (83% and 68%) compared with E-AAA repair (89% and 73%) and R-AAA repair (49% and 35%; P < .001). Conclusion The operative mortality of patients with Sx-AAA in contemporary practice appears better than that previously reported in the literature. Despite low operative mortality, MAE and late survival are intermediate compared with E-AAA and R-AAA repair. Review of previous series shows a trend for lower operative mortality after Sx-AAA repair in more recent series, which likely reflects improved perioperative care and more use of endovascular aneurysm repair.

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Section: Discussionsupporting

confidence: 88%

“…Such AAAs are termed symptomatic and represent 5.5% to 22% of all AAAs that require operation in previously reported surgical series. 2–8 …”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes of symptomatic abdominal aortic aneurysm repair

Martino

Nolan

Goodney

et al. 2010

Journal of Vascular Surgery

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“…Nevala and colleagues reported approximately 30% of the patient who underwent EVAR with the Zenith stentgraft required reintervention. 10) The authors focused on type II endoleak following Zenith stentgraft placement in another report, in which type II endoleak occurred in 22% of the patients, and reintervention was required in 6.4% of the entire cohort. They performed translumber or transarterial embolization with success rate of approximately 38%, and concluded the results of percutaneous reinterventions for type II endoleak were unsatisfactory.…”

Section: Methodsmentioning

confidence: 99%