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Online ISSN 1827-1847
Pulli R. 1, Dorigo W. 1, Marek J. 2, Di Mare M. 1, Troisi N. 1, Fargion A. 1, Calistri M. 1, Chiti E. 1, Matticari S. 1,
Alessi Innocenti A. 1, Pratesi G. 3, Pratesi C. 1
1 Department of Vascular Surgery University of Florence, Florence, Italy
2 Department of Vascular Surgery University of New Mexico, Albuquerque, NM, USA
3 Department of Vascular Surgery “Tor Vergata” University of Rome, Rome, Italy
Aim. The aim of this study was to analyze early and midterm results after endovascular abdominal aortic aneurysm repair (EVAR) on the basis of the type and morphology of the device employed.
Methods. From January 2000 to May 2008, 443 consecutive elective EVAR procedures using 9 different devices were performed at our institution. Data concerning the pre, intra and postoperative periods were prospectively collected in a dedicated database. Data related to the 4 most commonly used and currently available bifurcated endoprostheses were extracted and constitute the present study. Results in terms of technical success, aneurysm related morbidity and mortality (ARM) in both the perioperative period and during follow-up, need for secondary interventions, and patient survival were recorded and a device-related analysis was performed. Statistical analysis with SPSS 14.0 software was carried out and the different groups were compared by c2 and Fisher tests. For follow-up study Kaplan-Meier curves were performed and log-rank test was used for comparing the groups.
Results. A total of 391 EVAR procedures in 365 males (93%) and 26 females with a mean age of 74 years (range 52-91±7.4) were enrolled. More than 75% of the patients were ASA class III or IV. In 116 cases an Excluder (group 1), in 149 a Talent (group 2), in 77 a Zenith (group 3) and in 49 an Anaconda (group 4) endograft was deployed. Technical success was 98.7%. Thirty-day mortality and morbidity were satisfactory (0.8%and 4.8%) and no significant perioperative differences were recorded between the four groups. Mean follow-up was 26.0±21.9 (range 1-84) months. During follow-up 54 deaths, 76 endoleaks, 16 limb thromboses, 2 ruptures and 6 conversions to open repair occurred. Freedom from endoleak at 36 months was 84.4% in group 1, 90% in group 2, 84.4% in group 3 and 65.8% in group 4 (P=0.001). Overall, in 40 patients (10%) a reintervention was necessary. Freedom from reintervention at 36 months was 92% in group 1, 85% in group 2, 91% in group 3 and 77% in group 4 (P=NS).
Conclusion. Outcomes with the most common commercially available devices in Italy are satisfactory. Mortality and morbidity are quite low in the perioperative period and better than results reported in the literature with standard open repair. Midterm follow-up results are good with a 98% freedom from AAA rupture at 48 months, however, close follow-up is required with approximately 10% of patients requiring secondary interventions.