WHICH ANEURYSM CHARACTERISTICS PREDICT EVAR NON-SUCCESS?
DOI:
https://doi.org/10.48729/pjctvs.126Abstract
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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References
Blankensteijn JD, de Jong SM, Prinssen MM, et al; Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005; 352(23):2398-2405
Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm. JAMA. 2009;302(14):1535-1542.
Malina M, Resch T, Sonesson B.EVARand complex anatomy: An update on fenestrated and branched stent grafts. Scand J Surg 2008;97:195-204
Prinssen M, Verhoeven EL, Buth J, et al: A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351:1607-1618
http: / /ciberseguranca.spms.min-saude.pt/wp-content/uploads/2018/03/Guia-Privacidade-SMPS_RGPD_digital_20.03.172-v.2.pdf
Eur J Vasc Endovasc Surg (2011) 41, S1eS58
Piazza M et all; Role of aneurysm sac embolization during endovascular aneurysm repair in the prevention of type II endoleak-related complications;J Vasc Surg 2013 Apr;57(4):934-41. doi: 10.1016/j.jvs.2012.10.078. Epub 2013 Feb 4.
Piazza M et all, Definition of Type II Endoleak Risk Based on Preoperative Anatomical Characteristics, J Endovasc Ther. 2017 Aug;24(4):566-572. doi: 10.1177/1526602817712511. Epub 2017 Jun 5
Muthu C, Maani J, Plank LD, Holden A, Hill A. Strategies to reduce the rate of type II endoleaks: routine intraoperative embolization of the inferior mesenteric artery and thrombin injection into the aneurysm sac. J Endovasc Ther 2007;14:661-8
Schuurmann RCL et al, Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair, J Endovasc Ther. 2017 Jun;24(3):411-417. doi:
1177/1526602817700378. Epub 2017 Mar 28.
T. Ohrlander et al; Preoperative Spirometry Results as a Determinant for Long-term Mortality after EVAR for AAA; European Journal of Vascular and Endovascular Surgery 43 (2012) 43e47
Bendermacher BL et al; Influence of gender on EVAR outcomes with new low-profile devices; J Cardiovasc Surg (Torino). 2013 Oct;54(5):589-93.
Gallitto E et all, Impact of iliac artery anatomy on the outcome of fenestrated and branched endovascular aortic repair; J Vasc Surg. 2017 Sep 6. pii: S0741-5214(17)31359-9. doi: 10.1016/j.jvs.2017.04.063. [Epub ahead of print]
