Siena EVAR Score

Although several randomized trial and monocentric study reported good results EVAR of abdominal aortic aneurysm (AAA), the long-term results of EVAR is still debated for the incidence of complication and the necessity of reintervention and or surgical conversion. The aim of the present study was to generate a score to grade the risk of reintervention/conversion after EVAR.

We present a five-year prospective study. All patients with AAA and treated by EVAR were inserted in the study. Patients with ruptured AAA or treated with fenestrated-graft or chimney technique were excluded from the analysis. The rates of reintervention, surgical conversion and aneurysm-related death were recorded at 6 months after the procedure. Complication predictors were analyzed and was generated a numeric score for all the variables to predict the patient individual risk.

During the study period 976 EVAR procedures were successfully performed. No patients were lost during follow-up. We report 23 reinterventions (2.35%), the majority were performed electively. In six cases (0.61%) was performed conversion to surgical repair (1 graft infection, 3 for continuous growing of the aneurysmal sac and 2 cases for a ruptured AAA). In our experience, we report 4 deaths (0.4%) due to aneurysm rupture (1 case), acute myocardial infarction (2 cases) and colon cancer (1 case). The procedures were defined at low, moderate or high risk, respectively, according to whether the Siena EVAR Score was defined as EVAR1 (score <3), EVAR2 (3-6) or EVAR3 (>6).

Our Score could be an useful tool to predict patients individual risk after EVAR but, to be validated, needs to be analyzed in independents cohorts in different Center.