Long-term outcome after aortic endovascular repair: the Sydney experience

Since the inception of endovascular aortic aneurysm repair there has been concern about the unknown long-term outcome following this method of repair.

The purpose of this study is to present the outcome of patients with abdominal aortic aneurysms (AAAs) who were treated by endovascular repair between 5 and 11 years ago.

Between May 1992 and November 1997, 190 patients (175 males 15 females, mean age 72 years) were treated at the Royal Prince Alfred Hospital. Overall, 1 of 3 patients were considered to have comorbidities that precluded open repair. Endoprostheses used were first generation in two thirds of patients and second generation in one third of patients.

Eight patients (4.2%) died in the perioperative period. Endovascular repair failed in 20 patients (10.5%) who required conversion to open repair. Secondary conversion at a subsequent operation was necessary in 25 patients with rupture (n = 10), persistent endoleak (n = 11), endotension (n = 2), and inadvertent covering of the renal arteries by their prostheses (n = 2). Eight of the 20 patients presenting with rupture survived conversion to open repair. A long-term study of morphological changes in the proximal neck after endovascular AAA repair revealed a high probability (0.943 at 7 years) of no enlargement. Patients alive with successfully excluded AAA for 5-6, 6-7, 7-8, 8-9 year intervals of time, number 51, 36, 25, and 15, respectively.

Considering that one third of patients were unfit for open repair and two thirds were treated with first generation prostheses, these results support the continued use of the endovascular method to treat AAA.