ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2022 April;63(2):155-9

DOI: 10.23736/S0021-9509.21.12014-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Stability of the aneurysmatic sac post-EVAR could no longer be a reliable criterion of healing

Davide ESPOSITO ✉, Aaron T. FARGION, Walter DORIGO, Alberto MELANI, Amedeo CAPONE, Rossella DI DOMENICO, Flavio VILLANI, Sara SPEZIALI, Carlo PRATESI

Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy

BACKGROUND: Evaluation of the impact of aneurysm sac behavior in terms of either stability or shrinkage after endovascular aneurysm repair (EVAR) on long-term clinical outcomes.
METHODS: A retrospective study was conducted on 1483 consecutive patients who underwent EVAR from 1999 to 2021 at our institution. 1037 patients met inclusion criteria (1037/1483, 69.9%): abdominal aortic or aorto-iliac aneurysm, elective surgery, follow-up (FU) ≥12 months. Patients who had sac stability (330/1037, 31.8%) and patients who demonstrated sac shrinkage (542/1037, 52.2%) at FU were compared; patients who presented sac increase at FU were excluded (165/1037, 16%). Primary endpoints: rupture rates, need for surgical conversion, and long-term aneurysm-related mortality. Secondary endpoints: all type endoleak rates and long-term reintervention rates.
RESULTS: Mean FU was 61.2 months (IQ 26-85.7 months). In terms of comorbidities, the group of patients with stable sac showed greater association with polidistrectual atherosclerotic manifestations. Estimated 12-year survival was 42.9% in the stable sac group and 65% in the shrinked group (P<0.001), although there were no significant differences in terms of freedom from aneurysm-related death (97.3% vs. 95.4% estimated at 12 years, P=0.493). Patients with sac stability had higher rates of rupture (2.1% vs. 0.6%, P=0.035) and surgical conversion (2.1% vs. 0.6%, P=0.035). The stable sac group had significantly higher rates of all type endoleak during FU (45.8% vs. 24%, P<0.001). Estimated 12-year freedom from reintervention rates were 56.2% and 83.9% respectively (P<0.001).
CONCLUSIONS: After more than 20 years of EVAR experience it is probably time to reconsider the procedure clinical success parameters as a patient with a stable sac cannot be considered healed.

KEY WORDS: Aortic aneurysm, abdominal; Endovascular procedures; Endoleak; Aftercare