Midterm results of endovascular aneurysm sealing to treat abdominal aortic aneurysm

• Published in: Journal of vascular surgery 2019-01, Vol.69 (1), p.53-62.e1
• Main Authors: Stenson, Katherine M., Patterson, Benjamin O., Grima, Matthew Joe, De Bruin, Jorg L., Holt, Peter J.E., Loftus, Ian
• Format: Article
• Language: English
• Subjects: Abdominal aortic aneurysm; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - etiology; Aortic Rupture - surgery; Aortography - methods; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Computed Tomography Angiography; Endoleak - etiology; Endoleak - surgery; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Endovascular sealing; Female; Foreign-Body Migration - etiology; Foreign-Body Migration - surgery; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - surgery; Humans; Infrarenal; Learning Curve; London; Male; Reoperation; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2018.04.016

Endovascular aneurysm sealing (EVAS) represents a novel approach to the treatment of abdominal aortic aneurysms. It uses polymer technology to achieve an anatomic seal within the sac of the aneurysm. This cohort study reports the early clinical outcomes, technical refinements, and learning curve during the initial EVAS experience at a single institution. Results from 150 consecutive EVAS cases for intact, infrarenal abdominal aortic aneurysms are reported here. These cases were undertaken between March 2013 and July 2015. Preoperative, perioperative, and postoperative data were collected for each patient prospectively. The median age of the cohort was 76.6 years (interquartile range, 70.2-80.9 years), and 87.3% were male. Median aneurysm diameter was 62.0 mm (IQR, 58.0-69.0 mm). Adverse neck morphology was seen in 69 (46.0%) patients, including aneurysm neck length 32 mm or 60 degrees (15.3%). Median follow-up was 687 days (IQR, 463-897 days); 37 patients (24.7%) underwent reintervention. The rates of unresolved endoleak are 1.3% type IA, 0.7% type IB, and 2.7% type I. There were no type III endoleaks. There have been seven secondary ruptures in this cohort; all but one of these patients survived after reintervention. Only one rupture occurred in an aneurysm that had been treated within the manufacturer's instructions for use (IFU). The rate of unresolved endoleaks is satisfactorily low. The incidence of secondary rupture is of concern; however, when the IFU are adhered to, the rate is very low. The results of this study suggest that working within the IFU yields better clinical results. [Display omitted]