Predisposing Factors for Re-interventions with Additional Iliac Stent Grafts After Endovascular Aortic Repair

• Published in: European journal of vascular and endovascular surgery 2017-01, Vol.53 (1), p.89-94
• Main Authors: Roos, H, Sandström, C, Koutouzi, G, Jeppsson, A, Falkenberg, M
• Format: Article
• Language: English
• Subjects: Abdominal aorta; Aged; Aorta; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - surgery; Clinical Medicine; Dilatation, Pathologic; Endoleak - surgery; Endovascular Procedures - adverse effects; EVAR; Female; Foreign-Body Migration - surgery; Humans; Iliac Aneurysm - surgery; Iliac Artery - anatomy & histology; Iliac Artery - pathology; Iliac Artery - surgery; Klinisk medicin; Male; Reoperation; Retrospective Studies; Stent graft; Stents; Surgery
• ISSN: 1078-5884; 1532-2165; 1532-2165
• DOI: 10.1016/j.ejvs.2016.10.014

Background Endoleaks of type Ib and III are relatively common causes of re-intervention after EVAR. The aim was to determine underlying causes and identify anatomical factors associated with these re-interventions. Methods A total of 444 patients with standard bifurcated stent grafts were included in a retrospective observational study. Patients requiring additional iliac stent grafts ( n  = 24) were compared to those who did not ( n  = 420). Pre- and post-operative CT examinations were reviewed in patients with additional iliac stents. Reasons for re-interventions were defined as migration (>5 mm at the distal end or at interconnections), progression of disease (iliac artery diameter exceeding graft diameter), inadequate distal seal length at primary repair, or a combination of these factors. Results Twenty-four patients received 31 additional grafts in 30 limbs after a median 46 months (range 2–92 months). Five re-interventions (21%) were due to rupture. Re-intervened limbs had a larger iliac artery diameter 18 mm (25th and 75th percentile 20–25) versus 15 mm (13–18 mm), p