Brandsma, A.T.A. (2019) Endovascular Aneurysm Repair : Long term follow-up of early era EVAR; anatomic predictors for failure. thesis, Medicine.
Full text available on request.Abstract
Objective: Endovascular aneurysm repair (EVAR) has become the first line treatment for abdominal aortic aneurysms with lower perioperative mortality and morbidity compared with open repair. However long-term durability is not sustained. Aortic neck morphology influence stent graft durability, and baseline aorta anatomic characteristics are fundamental for selecting patients who are suitable for EVAR. This study aimed to evaluate the association between anatomical and proximal sealing zone characteristics on long-term stent graft complications in the early era of EVAR. Methods: In this large retrospective cohort study, we included all consecutive patients (n=279) with an infra-renal AAA who underwent EVAR between July 2008 and December 2013. We measured the anatomic variables of preoperative and postoperative CT-scans, using central luminal line reconstructions. Stent graft related reinterventions and complications were assessed. Results: A total of 230 patients were included, the mean age was 76 [IQR 71—82], and 12.6% were female. The median follow-up was 3.6 years, and overall mortality was 38.3%. Twenty-six per cent of patients had first stent graft related complications and 22.6% required reintervention. Hundred-sixty-five patients there pre- and postoperative scans were available and evaluated. Among patients with stent graft related complications, the proximal seal length was significant shorter compared with the group without complication (15 mm vs. 22 mm, p=0.004). In patients with a shorter aortic neck length we achieve less sealing length then is calculated (p=<0.001). Dilation of the initial neck diameter with more than 10% is associated with more stent graft complications (OR 2.2, 95% CI 1.2—4.3). Seventeen patients (7.8%) developed a type 1a endoleak during follow-up. Patients with a shorter aortic neck length (OR 1.0 per mm, 95% CI 0.9 – 1.0) and lesser seal length (OR 0.9 95% CI 0.8 – 0.9) developed significant more type 1a endoleaks. Conclusion: Our large retrospective study about the early experience with EVAR showed a high rate of stent-related complications and reinterventions. The proximal seal length during implantation is a protective factor for stent graft complication and type 1a endoleak. Also, we achieve an even significantly less proximal seal than is pre-calculated in patients with a shorter proximal neck and is consequently associated with more complications and type 1a endoleak. This underlines the importance of sealing in a “healthy” and longer part of the aorta and redefining the IFU is perhaps required. Better patient selection or creating a seal in a more proximal part of the aorta is recommended. Further research is needed for durability with a more recent cohort.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisors: and Prent dr. A. and and Laan, M.J. van der and Department of Vascular Surgery and Royal Free London NHS |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1591 |
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