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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
LATEST DEVELOPMENTS IN THE MANAGEMENT OF POST-EVAR COMPLICATIONS
The Journal of Cardiovascular Surgery 2014 October;55(5):593-600
Results of reinterventions for failed endovascular aortic repair: a single-center experience
Wijffels C. J. 1, 2, Van Lammeren G. W. 1, Waasdorp E. J. 2, Wille J. 1, Werson D. A. 1, Van Den Heuvel D. A. 3, De Vries J. P. 1 ✉
1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands;
2 Department of Surgery, Groene Hart Hospital, Gouda, the Netherlands;
3 Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
AIM: The aim of this paper was to review technical success and clinical outcome of reinterventions to treat complications after endovascular abdominal aortic aneurysm (AAA) repair (EVAR) in a tertiary vascular center.
METHODS: The study enrolled 107 patients treated for post-EVAR complications between January 2005 and March 2014. Details of reinterventions, technical success, and midterm clinical outcome were analyzed for reinterventions. Radiologic follow-up after reinterventions was performed by computed tomography scans and duplex ultrasonography.
RESULTS: Indications for reinterventions in the 107 patients were predominantly endoleaks type Ia, Ib, II, and III (55.1%). Endograft obstructions were observed in 39 patients (36.4%). The initial technical success rate for the 107 reinterventions was 93.5% (N.=100). Median follow-up postreintervention was 20 months (range, 1–107 months). During follow-up, 34 of 107 patients (31.8%) needed at least one renewed reintervention. Kaplan-Meier analysis of overall survival after the primary reinterventions was 85% at 1 year, and 78% at 3 years of follow-up. AAA/EVAR-associated mortality was 4% at 3 years. Kaplan-Meier survival estimation of freedom of recurrence was 88% at 1 year post-reintervention and 78% at 3 years. Renewed reintervention-free survival dropped to 78% at 1 year and 58% at 3 years.
CONCLUSION: In this series of patients, the technical success rate of reinterventions to treat post-EVAR complications was high. During a median follow-up of 20 months, AAA-associated mortality is low, but the need for renewed (endovascular) reinterventions is substantial.