ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2024 December;31(4):195-201

DOI: 10.23736/S1824-4777.24.01667-X

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

EVAR with supra-renal fixation endografts: results and outcomes

Rafael DE ATHAYDE SOARES ✉, Kaline AMARO, Ana I. NASSER, Marcus V. CURY, Keityane L. PEDROSA, Edson T. NAKAMURA, Roberto SACILOTTO

Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil

BACKGROUND: The main objective of this paper is to evaluate the outcomes regarding endoleaks, reinterventions, and death related to aneurysm complications in patients submitted to endovascular repair (EVAR) for abdominal aortoiliac aneurysm (AAA) using Endurant II (Medtronic) and Zenith Flex (Cook) endografts.
METHODS: This was a prospective, consecutive cohort study of patients with AAA who underwent EVAR with the use of Endurant II stent graft and Zenith Flex endograft.
RESULTS: A total of 156 patients submitted to EVAR were evaluated. The perioperative mortality was 5.1%, eight patients. There were 28 patients (17.9%) submitted to urgent repair of the aneurysm (expansion or rupture). There were 36 cases (23.1%) of later endoleak most of them Type II endoleak (21 patients, 13.4%). There were 12 cases of Type I endoleak. Moreover, regarding limb graft occlusion (LGO), there were nine patients (5.8%). The overall survival rates in a Kaplan-Meier at 720 days was 84.8% in total cohort. The freedom from reintervention rates in a Kaplan-Meier at 720 days was 92.7% in total cohort. The linear regression analysis for survival rates showed that chronic kidney disease (P=0.03; hazard ratio [HR] 2.82, CI 1.07-4.44), was the only factor related to poorer survival rates in both univariate and multivariate analysis. The linear regression analysis showed that the presence of endoleaks (P<0.001, HR=6.69, CI 2.26-8.48) and limb graft occlusion (P<0.001, HR=8.02, CI 1.60-9.99) were related to reintervention in both univariate and multivariate analysis.
CONCLUSIONS: In this present study, supra-renal fixation endografts devices were safe and efficient in treating AAA, with satisfactory results and no renal compromise. The linear regression analysis showed that the presence of endoleaks, and limb graft occlusion were related to higher reintervention rates in both univariate and multivariate analysis.

KEY WORDS: Aortic aneurysm; Vascular grafting; Endoleak