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Secondary Interventions and Long-term Follow-up after Endovascular Abdominal Aortic Aneurysm Repair.
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 2021 Feb; Vol. 71, pp. 381-391. Date of Electronic Publication: 2020 Aug 05. - Publication Year :
- 2021
-
Abstract
- Background: Early morbidity and mortality are low after endovascular abdominal aneurysm repair (EVAR), but secondary interventions and late complications are common. The aim of the present multicenter cohort study is to detail the frequency and indication for interventions after EVAR and the impact on long-term survival.<br />Methods: A retrospective multicenter cohort study of secondary interventions after elective EVAR for an infrarenal abdominal aortic aneurysm was conducted. Consecutive patients (n = 349) undergoing EVAR between January 2007 and January 2012 were analyzed, with long-term follow-up until December 2018. Those requiring intervention were classified in accordance with the indications and specific nature of the intervention and treatment. The primary study end point was overall survival classified for patients with and without intervention. Kaplan-Meier analysis was used to estimate overall survival for those who did and who did not undergo secondary interventions. Univariable and multivariable Cox regression were performed to identify independent variables associated with mortality.<br />Results: Some 56 patients (16%) underwent 72 secondary interventions after EVAR during a median (interquartile range) follow-up period of 53.2 months (60.1). Some 45 patients (80.4%) underwent one intervention. Indications for intervention included mainly endograft kinking/outflow obstruction and type II endoleak. An endovascular technique was used in 40.3% of interventions. Median time to secondary intervention was 24.1 months. In 93 patients with abnormalities on imaging, no intervention was performed mainly because the abnormality had disappeared on follow-up imaging (43%). Kaplan-Meier curves showed no difference in survival for patients with and without secondary interventions (P = 0.153). Age (hazard ratio [HR]: 1.089, 95% confidence interval [CI]: 1.063-1.116), ASA classification (ASA III, IV HR: 1.517, 95% CI: 1.056-2.178) were significantly related to mortality.<br />Conclusions: Secondary intervention rates are still considerable after EVAR. Endograft kinking/outflow obstruction and endoleak type II are the most common indications for a secondary intervention. Secondary interventions did not adversely affect long-term overall survival after EVAR.<br /> (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal diagnostic imaging
Aortic Aneurysm, Abdominal mortality
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation instrumentation
Blood Vessel Prosthesis Implantation mortality
Endoleak diagnostic imaging
Endoleak etiology
Endoleak mortality
Endovascular Procedures instrumentation
Endovascular Procedures mortality
Female
Graft Occlusion, Vascular diagnostic imaging
Graft Occlusion, Vascular etiology
Graft Occlusion, Vascular mortality
Humans
Incidence
Male
Netherlands epidemiology
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Aortic Aneurysm, Abdominal surgery
Blood Vessel Prosthesis Implantation adverse effects
Endoleak surgery
Endovascular Procedures adverse effects
Graft Occlusion, Vascular surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1615-5947
- Volume :
- 71
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32768546
- Full Text :
- https://doi.org/10.1016/j.avsg.2020.07.042