Endovascular aneurysm repair for symptomatic abdominal aortic aneurysms has comparable results to elective repair in the long term

• Published in: Journal of vascular surgery 2020-12, Vol.72 (6), p.1927-1937.e1
• Main Authors: Abdulrasak, Mohammed, MD, Sonesson, Björn J., MD, PhD, Vaccarino, Roberta, MD, Singh, Bharti H., MD, Resch, Timothy A., MD, PhD, Dias, Nuno V., MD, PhD
• Format: Article
• Language: English
• Subjects: Abdominal aortic aneurysm; Aged; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Endovascular aneurysm repair; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Female; Humans; Male; Postoperative Complications - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Stent graft; Stents; Surgery; Symptomatic AAA; Time Factors; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2020.03.027

AbstractObjectiveEndovascular aneurysm repair (EVAR) has been extensively study regarding elective and ruptured abdominal aortic aneurysm (AAA) repair. However, much less is known about EVAR of symptomatic nonruptured AAA, especially concerning the long-term results. The aim of this study was to assess the outcomes of EVAR of symptomatic AAA compared with asymptomatic AAA at a tertiary center using a single graft. MethodsAll consecutive patients treated for symptomatic and asymptomatic AAAs from 1998 to 2012 at our institution, using the Cook Zenith stent graft (Cook Europe A/S, Bjaeverskov, Denmark), were included in the study. Ruptured AAAs were excluded. Patients' charts were reviewed to obtain preoperative, intraoperative, and postoperative data. All available imaging was reviewed. Life tables were constructed to assess for overall and late AAA-related survival, clinical success, and endoleak freedom. ResultsThere were 680 patients included (137 symptomatic AAAs). No difference in technical success rate (96.1% for asymptomatic AAAs vs 94.9% for symptomatic AAAs) was present ( P = .477). Thirty-day mortality was more common in symptomatic AAAs (6.6% vs 1.5% for asymptomatic AAAs; P = .002). Freedom from reinterventions was 72% ± 3% for asymptomatic AAAs vs 73% ± 5% for symptomatic AAAs ( P = .785) at 10 years postoperatively. There was no difference in primary ( P = .300) or secondary ( P = .099) clinical success between groups, although there was higher assisted clinical success ( P = .023) for asymptomatic AAAs compared with symptomatic AAAs. Persistent late clinical failure was similar in both groups (14.2% for asymptomatic AAAs vs 15.3% for symptomatic AAAs; P = .732). Freedom from late AAA-related death was higher ( P = .016) for asymptomatic AAAs compared with symptomatic AAAs, but the differences disappeared when the first 30 days were disregarded. Overall survival ( P = .687) was similar in both groups. An adequate aneurysm neck preoperatively conferred a better outcome in end points including overall survival. ConclusionsSymptomatic AAAs have an almost quadrupled 30-day mortality compared with asymptomatic AAAs, but the outcome differences fade in the long term. An adequate aneurysm neck was associated with better outcomes including overall survival independent of the initial presentation of the AAA. These results suggest the need of improving the identification of symptomatic patients requiring preoperative medical optimization. However, this