Elsevier

Journal of Vascular Surgery

Clinical Enquiry Studies from the New England Society for Vascular Surgery

Clinical failures of endovascular intestinal aortic aneurysm repair: Incidence, causes, and management☆,☆☆

Presented at the Twenty-eighth Annual Coming together of the New England Society for Vascular Surgery, Providence, RI, Sep 19-21, 2001.

Abstract

Objective: Despite well-documented good early results and benefits of endoluminal stent graft repair of intestinal aortic aneurysm (J Vasc Surg 2002;35:1137-44.)(AAA), the long-term outcome of this method of handling remains uncertain. In detail, business concern exists that tardily effectiveness and durability are inferior to that of open repair. To determine the incidence and causes of clinical failures of endovascular AAA repair, a 7-yr feel with 362 primary AAA endografts was reviewed. Methods: Clinical failures were defined equally deaths within xxx days of the procedure, conversions (early on and late) to open AAA repair, AAA rupture after endoluminal treatment, or AAA sac growth of more than 5 mm in maximal diameter despite endograft repair. Endoleak status per se was not considered unless it resulted in an adverse issue. If clinical issues arose only could be corrected with catheter-based therapies or limited surgical procedures, thereby maintaining the integrity of successful stent graft treatment of the AAA, such cases were considered as primary assisted success and not classified every bit clinical failures. Results: The average follow-up menses was i.5 years. Six deaths (1.6%) occurred after the process, all in elderly patients or patients at high risk. Five patients (1.iv%) needed early conversion (immediate, 2 days) to open repair for access problems or technical difficulties with deployment, resulting in an implantation success rate of 98.6%. 8 patients (two.2%) underwent late conversion for a variety of problems, including AAA expansion (northward = 4), endograft thrombosis (north = one), secondary graft infection (n = ii), and rupture at 3 years (n = 1). Rupture occurred in an boosted two patients for a total incidence rate of 0.8%. AAA sac growth of greater than 5 mm was observed in 20 patients (5.6%), iv of whom have undergone successful catheter-based treatments to date. Overall, 39 patients (10.7%) needed catheter-based (n = 45) or express surgical (northward = 4) reinterventions for a variety of late problems that were successful in 92%. Conclusion: In our 7-year experience, ane or more clinical failures of endovascular AAA repair were observed in 31 patients (viii.3%). Reinterventions were necessitated in a full of 10.7% of patients but were unremarkably successful in maintaining AAA exclusion and limiting AAA growth. These results emphasize that endovascular repair provides good results and many benefits for virtually properly selected patients but is non as durable equally standard open repair. (J Vasc Surg 2002;35:1137-44.)

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