Author(s): Hobo R, Buth J EUROSTAR collabo
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Abstract OBJECTIVE: The purpose of this study was to evaluate the need for secondary interventions after endovascular abdominal aortic aneurysm repair with current stent-grafts. METHODS: Studied were data from 2846 patients treated from December 1999 until December 2004. The data were recorded from the EUROSTAR registry. The only patients studied were those with a follow-up of at least 12 months or until they had a secondary intervention within the first 12 months. The cumulative incidences of secondary transabdominal, extra-anatomic, and transfemoral interventions during follow-up (after the first postoperative month) were investigated. RESULTS: A secondary intervention was performed in 247 patients (8.7\%) at a mean of 12 months after the initial procedure within a follow-up period of a mean of 23 +/- 12 months. Of these, 57 (23\%) transabdominal, 43 (16\%) involved an extra-anatomic bypass, and 147 (60\%) were by transfemoral approach. The cumulative incidence of secondary interventions was 6.0\%, 8.7\%, 12\%, and 14\% at 1, 2, 3, and 4 years, respectively. This corresponded with an annual rate of secondary interventions of 4.6\%, which was remarkably lower than in a previously published EUROSTAR study of patients treated before 1999. Type I endoleaks (33\% of procedures), migration (16\%), and rupture (8.8\%) were the most frequent reasons for secondary transabdominal interventions. Graft limb thrombosis was the indication for extra-anatomic bypass (60\%). Type I endoleak (17\%), type II endoleak (23\%), device limb stenosis (14\%), thrombosis (23\%), and device migration (14\%) were the most frequent reasons for secondary transfemoral interventions. Operative mortality was higher after secondary transabdominal interventions (12.3\%, P = .007) compared with transfemoral interventions (2.7\%). Overall survival was lower in patients with secondary transabdominal (P = .016) and extra-anatomic interventions (P < .0001) compared with patients without a secondary intervention. CONCLUSION: Although the incidence of secondary interventions after endovascular aneurysm repair has substantially decreased in recent years, continuing need for surveillance for device-related complications remains necessary.
This article was published in J Vasc Surg
and referenced in Journal of Vascular Medicine & Surgery