Re-interventions after endovascular aortic repair for infrarenal abdominal aneurysms: a retrospective cohort study

• Published in: BMC cardiovascular disorders 2016-06, Vol.16 (1), p.124-124, Article 124
• Main Authors: Roos, Håkan, Djerf, Henrik, Brisby Jeppsson, Ludvig, Fröjd, Victoria, Axelsson, Tomas, Jeppsson, Anders, Falkenberg, Mårten
• Format: Article
• Language: English
• Subjects: Aged; Aortic aneurysm; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Blood Vessel Prosthesis - adverse effects; Cardiac and Cardiovascular Systems; Care and treatment; Complications and side effects; Endoleak; Endoleak - diagnosis; Endoleak - surgery; Endovascular Procedures - methods; Endovascular stents; Endovascular technique; eurostar; evar; evolution; Female; Follow-Up Studies; Humans; Kardiologi; Male; mortality; outcomes; Prosthesis Failure; registry; reintervention; Reoperation; Retrospective Studies; Risk factors; secondary interventions; Stents; survival; Time Factors; Treatment Outcome; trial
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-016-0309-0

Early morbidity and mortality are generally lower after endovascular aortic repair (EVAR), than after open repair but re-interventions and late complications are more common. The aim of the present study was to make a detailed description of re-interventions after EVAR-including incidence, indications, procedures, and outcome-with special reference to non-access-related re-interventions. This is a retrospective single-center cohort study of re-interventions after standard EVAR with special reference to non-access-related re-interventions. Consecutive patients (n = 405) treated with standard EVAR for non-ruptured (n = 337) or ruptured (n = 68) infrarenal aneurysms between 2005 and 2013 were analysed. Median follow-up was 29 months (range 0-108). Eighty-nine patients (22 %) underwent 113 re-interventions during follow-up. Twenty-seven patients (7 %) had 28 access related re-intervention, 65 patients (16 %) had 85 non-access related reinterventions. Non-access related re-interventions were more common in ruptured aneurysms than in unruptured aneurysms (22 vs. 15 %, p = 0.002). The most frequent indications were endoleak type I (n = 19), type II (n = 21), or type III (n = 5); stent graft migration (n = 9); and thrombosis (n = 14). The most frequent procedures were embolization of endoleak type II (n = 21), additional iliac stent graft (n = 19), proximal extension (n = 12), thrombolysis (n = 8), iliac limb bare-metal stenting (n = 6), and stent graft relining (n = 7). Endovascular technique was used in 83 % of re-interventions. Thirty-day mortality after non-access-related re-interventions was 15 % when initiated from symptoms (rupture or infection) and 0 % when initiated from follow-up findings (p = 0.014). Cumulative survival five years after EVAR was 72 % in patients with a re-intervention and 59 % in patients without (p = 0.21). Non-access-related re-intervention rates are still considerable after EVAR and more frequent after ruptured aneurysms. Endoleak embolization is the most frequent procedure, followed by additional iliac stent grafts. Outcomes after re-interventions are generally good, except when initiated by rupture or infection.