Ten-year outcomes after endovascular aneurysm repair (EVAR) and magnitude of additional procedures.
OBJECTIVE
With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The longterm outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered.


METHODS
Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54-85) with AAA (average 57mm, range 40-90mm) were treated with a Vanguard endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually.


RESULTS
The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6-120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery disease. There were ten late conversions to open surgical repair, including three emergency operations: two due to rupture and one to thrombosis. EVAR-related complications were encountered in 43 patients (90%): 12 primary endoleaks (all type II), 36 late endoleaks (16 type I, 2 type II and 18 type III), 22 migrations, 25 row separations, 20 thromboses, one endotension and 3 ruptures of the AAA. Secondary procedures were required in 39 patients (81%): 1 re-endografting by aortoiliac bifurcated graft and 3 with a uni-iliac graft; 33 limb graft repairs were performed and 19 infrarenal cuffs were placed. There were 4 late embolizations and 4 attempts, and 6 thrombolyses, four of which were successful. Further, 9 femoro-femoral crossover by-pass and 2 axillofemoral by-pass operations and 2 amputations were carried out during the follow-up. Only one patient was alive without complications.


CONCLUSIONS
The impact of long-term follow-up of patients treated with the new technology was emphasized in this patient population. A careful surveillance protocol and active endovascular treatment of complications can yield acceptable results and low AAA rupture and aneurysm mortality rates, also with the first-generation endovascular graft. A new technology, however, may involve unpredictable problems which can magnify the workload and incur high costs over several years after the initial procedure.
Väärämäki
S
S
Division of Vascular Surgery and Interventional Radiology, University Hospital and Medical School, Tampere, Finland.
Pimenoff
G
G
Heikkinen
M
M
Suominen
V
V
Saarinen
J
J
Zeitlin
R
R
Salenius
J
J
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017546:Angioscopy / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome