Secondary interventions following endovascular repair of abdominal aortic aneurysm

To review the outcomes of endovascular abdominal aortic aneurysm repair (EVAR) procedures, to determine the incidence of adverse events, and to assess the need for secondary radiological/surgical interventions.

Data from 57 consecutive patients entered in a prospective EVAR database were studied. In addition to database interrogation, case notes and radiology records were reviewed. Frequency and outcome of complications were evaluated after stent-graft placement (mean follow up 20 months).

Overall, 24 adverse events were recorded in 57 patients (42%). The events were endoleaks (14/24), stent migrations (3/24), deployment problems (2/24), limb occlusions (2/24), limb kink (1/24), and femoro-femoral crossover occlusions (2/24). Of all the endovascular patients studied, 23% (13/57) required secondary interventions to maintain aneurysm exclusion. The mean time to secondary intervention in this series was 14 months.

Over 40% of EVAR procedures were associated with suboptimal clinical outcomes, and more than 20% of the patients required secondary interventions within 5 years of surgery. This high incidence of late secondary intervention is a cause for concern and emphasizes the need for lifelong follow-up.