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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2018 Jan 09

DOI: 10.23736/S0021-9509.18.10388-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Is EVAR a durable solution: indications for re-interventions

Louise de la MOTTE 1 , Mårten FALKENBERG 3, Mark J. KOELEMAY 4, Lars LÖNN 2

1 Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 2 Department of Cardiovascular Radiology, Faculty of Health Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; 3 Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; 4 Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands


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AIM: Indications for re-interventions after endovascular aneurysm repair (EVAR), as well as their occurrence in number and time, are important to establish in order to optimize patient selection, post-procedure surveillance and also to guide improvements in endograft designs. The aim of this report was to present an overview of current data on re-interventions after elective EVAR.
METHODS: Qualitative review of studies reporting on re-interventions after elective EVAR, identified by a systematic literature search in MEDLINE, EMBASE and the Cochrane Library for publications from 2010 to 13th of November 2017.
RESULTS: Twenty-three studies reporting on 83,307 patients met the inclusion criteria. Index procedures were performed between 1996-2014. There was wide heterogeneity in reporting standards. Type I endoleaks were reported in 0.6%-13% and type III endoleaks in 0.9%-2.1% with a significant improvement for newer devices. Migration rates varied between 0%-4%. Endoleak type II was the most common indication for re-intervention ranging from 14%-25.3% although the majority resolved without intervention. Rupture rates ranged from 0%-5.4% and carried a high mortality (60%-67%). Ruptures occurred at any time after the index procedure. Limb ischemia rates were reported at 0.4%-11.9% with re-intervention rates between 0.06%-11.9%. Wound related complications and related re-interventions were the indication in 0.5%-14% and 0.3%-6.5%, respectively. Endograft infection carried a high risk of mortality and was described in 0.3%-3.6%, often related to graft-enteric fistula and the majority had an open explantation of the endograft.
CONCLUSIONS: This review showed that the rates of complications and techniques for re-intervention developed over time with a tendency towards better outcomes considering the aneurysm related indications. Significant factors that led to subsequent secondary interventions were migration, rupture, infections and type I and II endoleaks. Patients treated with earlier generation endografts are still alive and need continued surveillance to detect these severe complications before they lead to rupture.


KEY WORDS: Abdominal aortic aneurysm - Endovascular repair - EVAR - Re-intervention - Complications - Follow-up - Rupture - Endoleak

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Publication History

Article first published online: January 9, 2018
Manuscript accepted: January 3, 2018
Manuscript received: December 21, 2017

Per citare questo articolo

de la Motte L, Falkenberg M, Koelemay MJ, Lönn L. Is EVAR a durable solution: indications for re-interventions. J Cardiovasc Surg 2018 Jan 09. DOI: 10.23736/S0021-9509.18.10388-0

Corresponding author e-mail

Louise.de.la.motte@regionh.dk