REVIEW  THE FATE OF AORTA AFTER ENDOVASCULAR ANEURYSM REPAIR 

The Journal of Cardiovascular Surgery 2019 April;60(2):175-85

DOI: 10.23736/S0021-9509.19.10854-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Outcomes of endovascular treatment of endoleak type Ia after EVAR: a systematic review of the literature

Konstantinos SPANOS ✉, Fiona ROHLFFS, Giuseppe PANUCCIO, Ahmed ELESHRA, Nikolaos TSILIMPARIS, Tilo KÖLBEL

Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany

INTRODUCTION: Endovascular repair of infra-renal aortic aneurysm (EVAR) has become treatment of choice. However, individuals undergoing EVAR have a high re-intervention rate. The aim of this study is to evaluate the current endovascular treatment modalities of endoleak type Ia (ET Ia) treatment after EVAR and their outcome.
EVIDENCE ACQUISITION: A systematic review and meta-analysis was performed. MEDLINE, EMBASE and Cochrane databases were searched with PRISMA methodology for studies reporting on endovascular treatment of ET Ia after EVAR. Studies presenting treatment of intra-operative ET Ia were excluded.
EVIDENCE SYNTHESIS: Two international registries, fourteen non-randomized retrospective and twelve case-report studies were included reporting on 356 patients. Reported endovascular techniques included fenestrated-, branched-, chimney EVAR, endovascular sealing (EVAS), endoanchors, embolization techniques, cuff and/or “giant” Palmaz stents. Technical success rate ranged from 90% to 100%, with intra-operative mortality rate of 0%. During early period, persistence of ET Ia was 3.4% (9/262) and the re-intervention rate was 3.5% (8/227). The 30-day mortality rate was 2% (7/356). Mean follow-up was 22.4 months±18. Presence of ET Ia was 5.9% (21/356), and the reintervention rate was 5.1% (18/349). The mortality rate was 13% (26/203), while the primary patency rate of TVs ranged from 94.3% to 100%.
CONCLUSIONS: A multitude of techniques for endovascular repair for ET Ia exists. No strong evidence supports one specific technique. The early and mid-term outcomes are encouraging in terms of ET Ia resolution, mortality and morbidity rates.

KEY WORDS: Endoleak - Endovascular procedures - Aortic aneurysm