Ten-Year Outcomes after Endovascular Aneurysm Repair (Evar) and Magnitude of Additional Procedures

• Published in: Scandinavian journal of surgery Vol. 96; no. 3; pp. 221 - 228
• Main Authors: Väärämäki, S., Pimenoff, G., Heikkinen, M., Suominen, V., Saarinen, J., Zeitlin, R., Salenius, J.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2007
• Subjects: Aged; Aged, 80 and over; Angiography; Angioscopy - methods; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - methods; Female; Finland - epidemiology; Follow-Up Studies; Humans; Male; Middle Aged; Prosthesis Design; Retrospective Studies; Stents; Survival Rate - trends; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; endoleak; secondary interventions; endovascular repair; complications; Abdominal aortic aneurysm; long-term outcome; migration
• ISSN: 1457-4969; 1799-7267
• DOI: 10.1177/145749690709600307

Background and Aims:
With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The long-term outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered.
Materials and Methods:
Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54–85) with AAA (average 57mm, range 40–90mm) were treated with a Vanguard® endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually.
Results:
The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6–120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery disease. There were ten late conversions to open surgical repair, including three emergency operations: two due to rupture and one to thrombosis. EVAR-related complications were encountered in 43 patients (90%): 12 primary endoleaks (all type II), 36 late endoleaks (16 type I, 2 type II and 18 type III), 22 migrations, 25 row separations, 20 thromboses, one endotension and 3 ruptures of the AAA. Secondary procedures were required in 39 patients (81%): 1 re-endografting by aortoiliac bifurcated graft and 3 with a uni-iliac graft; 33 limb graft repairs were performed and 19 infrarenal cuffs were placed. There were 4 late embolizations and 4 attempts, and 6 thrombolyses, four of which were successful. Further, 9 femoro-femoral crossover by-pass and 2 axillo-femoral by-pass operations and 2 amputations were carried out during the follow-up. Only one patient was alive without complications.
Conclusions:
The impact of long-term follow-up of patients treated with the new technology was emphasized in this patient population. A careful surveillance protocol and active endovascular treatment of complications can yield acceptable results and low AAA rupture and aneurysm mortality rates, also with the first-generation endovascular graft. A new technology, however, may involve unpredictable problems which can magnify the workload and incur high costs over several years after the initial procedure.