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Italian Journal of Vascular and Endovascular Surgery 2017 December;24(4):137-45

DOI: 10.23736/S1824-4777.17.01303-1


language: English

A French comparative monocentric study of reimboursed stent-grafts for abdominal aortic aneurysms

Francesca PICCOLI 1 , Jean M. ALSAC 2, 3, Salma EL BATTI 2, 3, Marco SANDRI 4, Paola ZUCCOLOTTO 5, Pierre JULIA 2, 3

1 Università degli Studi di Pavia, Pavia, Italy; 2 Unit of Cardiovascular, Georges Pompidou European Hospital, Paris, France; 3 Faculty of Medicine “René Descartes”, University of Paris 5, Paris, France; 4 Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy; 5 Big & Open Data Innovation Laboratory, University of Brescia, Brescia, Italy


BACKGROUND: Endovascular treatment of abdominal aortic aneurysms (AAA) has become more common and is expected to fit best for high risk patients even if it displays an increased number of secondary reintervention when compared to open surgery.
METHODS: Cohort study of 311 consecutive patients with AAAs treated by endovascular repair from 2004 to 2015 in a single University Hospital were analyzed and included in the study. We computed Kaplan-Meier life tables to estimate all-cause survival at 30 days and 1 year as well as to estimate rate of endovascular and global (endovascular + surgical) reintervention, incidence of endoleaks and of aneurysm progression at 1 month, 3 months, 6 months and 1 year. Patients were observed from the date of intervention.
RESULTS: Sixty-eight patients were lost to follow-up. No statistically significant differences emerged from the comparison of 30 days mortality between the 6 endograft groups (overall rate 1.7%, P=0.787). No significant differences of mean aneurysm diameter reduction recorded within 1 year from intervention were observed between the groups. Overall diameter stability, regression and progression occurred in 82.5%, 12.5% and 4.5%, respectively. Cook device displayed the highest incidence of type I endoleak within the 1st postoperative year (11.5% vs. 2.4%; HR=4.48, 95% CI: 1.05-19.20, P=0.043) while Gore and Anaconda devices of type II endoleaks within the same period (49.5% vs. 26.0%; HR=1.78, 95% CI: 0.95-3.33, P=0.073). Endovascular aneurysm repair treatment failed in 16 patients (5.1%) who were thus converted to open surgery.
CONCLUSIONS: Gore and Cook devices resulted those with the highest incidence of type II endoleaks and of global reintervention while AFX resulted the device with the lowest incidence of both the events mentioned. In conclusion, regular follow-up of patients is mandatory for the effectiveness of endovascular treatment and to detect early complications and when EVAR fails, open surgical repair is still a reasonable surgical alternative.

KEY WORDS: Aortic aneurysm, abdominal - Endoleak - Endovascular procedures

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