WHICH ANEURYSM CHARACTERISTICS PREDICT EVAR NON-SUCCESS?
Introduction: Hostile anatomic characteristics in patients undergoing endovascular abdominal aortic aneurysm repair (EVAR) may lead to technical non-success, late complications, reintervention or death.
Objective: To analyze specific anatomical features of abdominal aortic aneurysms and to study the association with postoperative endoleak and survival.
Methods: Retrospective review of all consecutive elective EVARs between 2010 and 2016, with available data, at one institution, for infra-renal aortic aneurysms. Patients comorbidities and preoperative computed tomography scans were analyzed considering characteristics of the proximal and distal landing zones, the aortic aneurysm and eventual concomitant iliac aneurysm or peripheral occlusive disease. Outcomes were endoleak development and survival.
Results: We analyzed 56 patients, 54 (96%) male with a mean age of 78 (min 61, max 89) years. During a mean of 3.4 years of follow up, 12 (21%) patients developed endoleak (10 type II and 2 type I) and 18 (32%) died. The adjusted analysis showed a significant association between aneurysm angulation (p=0.044), patency of the inferior mesenteric artery and the lumbar arteries (p=0.044) and aneurysm diameter (p=0.009) with endoleak development. All except one endoleak were diagnosed within the first year after EVAR. None of the deaths that occurred during the follow up period were correlated to post intervention aneurysm enlargement or rupture.
Conclusion: Unfavorable aneurysm morphologic characteristics for EVAR may predict complicated endograft placement or higher incidence of post intervention endoleak, which should be taken into consideration. For such clinical cases, complementary endovascular procedures or a surgical approach should be considered.
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