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Does complete aneurysm exclusion ensure long-term success after endovascular repair?
W A Lee1, Y G Wolf, T J Fogarty
1Division of Vascular Surgery, Stanford University School of Medicine, California, USA. leewa@mail.surgery.ufl.edu
Insights
Complete aneurysm exclusion after endovascular abdominal aortic aneurysm (AAA) repair does not guarantee long-term success. Adverse events occurred similarly in patients with and without initial endoleak, indicating a need for better success markers.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Management
Background:
- Endovascular abdominal aortic aneurysm (AAA) repair is a common treatment.
- Complete aneurysm exclusion is often considered a marker of successful repair.
- Long-term outcomes and the reliability of this marker require further investigation.
Purpose of the Study:
- To determine if complete aneurysm exclusion is a reliable indicator of successful long-term endovascular AAA repair.
- To assess the association between initial endoleak status and major adverse events post-repair.
Main Methods:
- Retrospective review of medical records, CT scans, and duplex examinations for 67 patients with at least 12 months of follow-up after endovascular AAA repair.
- Complete aneurysm exclusion defined as the absence of endoleak before an adverse event.
- Primary endpoint included major adverse events: aneurysm expansion, acute symptoms, secondary procedures, and deaths.
Main Results:
- 42% of patients (28/67) experienced at least one major adverse event.
- Among patients with initial complete exclusion (no endoleak), 33% (12/36) had adverse events.
- Patients with initial endoleak had a similar rate of adverse events (52%, 16/31), with no statistically significant difference (p = 0.21).
Conclusions:
- Complete aneurysm exclusion, defined by the absence of endoleak, is not a statistically significant predictor of an event-free postoperative course.
- The presence or absence of an initial endoleak did not correlate with a significant difference in adverse events.
- Current definitions of complete exclusion are insufficient; a more robust marker for clinical success in endovascular AAA repair is necessary.
Purpose:
To examine whether complete aneurysm exclusion is a reliable marker for successful long-term endovascular abdominal aortic aneurysm (AAA) repair.
Methods:
The medical records, computed tomographic (CT) scans, and duplex examinations of all the patients who underwent endovascular AAA repair at a single institution and had at least 12 months of follow-up were reviewed. Sixty-seven patients (58 men; mean age 74 years, range 57-87) were identified. Complete aneurysm exclusion was defined by the absence of an endoleak at any time before an adverse event. The primary endpoint included all major adverse events that occurred during the postoperative period, including aneurysm expansion, acute symptoms referable to the AAA, late secondary procedures, ruptures, and deaths from ruptures and all other causes.
Results:
There were 44 adverse events (8 expanding aneurysms, 4 acute symptoms, 17 secondary procedures, and 15 deaths from other causes) in 28 (42%) patients. Among 36 (54%) patients who had initial complete aneurysm exclusion (no endoleak), 12 (33%) experienced adverse events, compared with 16 (52%) events in 31 patients who had endoleak (chi2 = 1.59, p = 0.21).
Conclusions:
There was no statistically significant difference in adverse events based on the presence or absence of endoleak. Complete aneurysm exclusion as defined by absence of an endoleak does not indicate an event-free postoperative course. A better marker of clinical success of endovascular AAA repair is needed.