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Aneurysm rupture after EVAR: can the ultimate failure be predicted?

F J V Schlösser1, R J Gusberg, A Dardik

  • 1Section of Vascular Surgery, Yale University, New Haven, CT 06510, United States.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|November 15, 2008
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Summary

AAA rupture after EVAR is often caused by endoleaks or graft migration within 2-3 years. Enhanced surveillance and improved stent-graft durability are key to reducing rupture risk.

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Area of Science:

  • Vascular Surgery
  • Endovascular Aneurysm Repair (EVAR)
  • Abdominal Aortic Aneurysm (AAA)

Background:

  • Endovascular Aneurysm Repair (EVAR) is a common treatment for Abdominal Aortic Aneurysms (AAA).
  • However, AAA rupture can still occur after EVAR, necessitating an understanding of its causes and timing.

Purpose of the Study:

  • To investigate the primary causes and temporal patterns of AAA rupture following EVAR.
  • To identify risk factors associated with AAA rupture post-EVAR.

Main Methods:

  • Systematic review and data extraction from MEDLINE and EMBASE databases for AAA ruptures post-EVAR.
  • Analysis of patient and procedural characteristics in identified cases.

Main Results:

  • 270 AAA ruptures post-EVAR were identified, with endoleaks (160 cases) and graft migration (41 cases) as primary causes.
  • Most ruptures occurred within 2-3 years post-EVAR, often in patients with large initial AAA diameters (mean 65 mm).
  • Structural graft failure occurred in 96 patients, and 119 experienced a fatal outcome.

Conclusions:

  • Intensified surveillance in the first 2-3 years post-EVAR may lower rupture rates, particularly for high-risk patients.
  • Improved stent-graft durability and longevity are crucial for reducing AAA rupture risk.
  • Complete prevention remains challenging as ruptures can occur without identifiable predisposing factors.