title: Long-term outcomes of secondary procedures after endovascular aneurysm repair.
abstract: OBJECTIVE
  This study evaluated the outcomes of secondary procedures after endovascular aneurysm repair (EVAR).
  
  
  METHODS
  From 2002 to 2009, 1768 patients underwent EVAR for treatment of 1662 elective (94%) and 106 emergent (6%) infrarenal abdominal aortic aneurysm (AAA) with a variety of Food and Drug Administration-approved and commercially available stent grafts. Postoperative follow-up included clinical examination, pulse volume recording, duplex ultrasound imaging, and computed tomography and magnetic resonance angiography at 1, 6, and 12 months, and yearly thereafter. Patients with type I and III endoleaks, unexplained endotension, limb occlusion, stent graft migration, with and without type I endoleak, and aneurysm rupture underwent secondary interventions. Type II endoleak at >6 months without a decrease in the aneurysm sac underwent translumbar embolization. Data were prospectively collected.
  
  
  RESULTS
  EVAR was performed in 1768 patients. During a mean follow-up of 34 (SD, 30.03) months, 339 patients (19.2%) required additional secondary procedures for aneurysm-related complications, including type I (n = 51, 15.0%), type II (n = 136, 40.1%), and type III (n = 5, 1.5%) endoleaks; endotension (n = 8, 2.4%), stent graft migration proximal fixation site (n = 46, 13.6%), stent graft iliac limb thrombosis or stenosis (n = 25, 7.4%), subsequent iliac aneurysm formation (n = 39, 11.5%), or aneurysm rupture after EVAR (n = 29, 8.6%). The mean age was 74 (SD, 9.15) years. Mean AAA size was 5.7 (SD 3.24) cm. Compared with secondary procedures for AAA rupture, the nonrupture patients had a significantly lower mortality (1.6% vs 17.2%, P < .05) and a higher likelihood of being managed by endovascular means (98.8% vs 44.8%, P < .05). When nonruptured EVAR patients required urgent secondary procedures for type I endoleaks and stent graft migration or limb thrombosis, the mortality was 6.0% vs 0.5% for elective procedures (P < .05).
  
  
  CONCLUSIONS
  Our long-term EVAR experience indicates that 18% of patients require additional secondary procedures, and most of these patients can be managed by endovascular means with an acceptable overall mortality of 2.9%. Most type I and II endoleaks can be successfully treated by transluminal embolization, and most patients with delayed aneurysm rupture after EVAR can be successfully managed by endovascular or open surgical repair.
authors: The Institute for Vascular Health and Disease, Albany Medical College, The Vascular Group, Albany, NY 12205, USA. mehtam@albanyvascular.com
authors: Manish
authors: M
authors: Mehta
authors: Yaron
authors: Y
authors: Sternbach
authors: John B
authors: JB
authors: Taggert
authors: Paul B
authors: PB
authors: Kreienberg
authors: Sean P
authors: SP
authors: Roddy
authors: Philip S K
authors: PS
authors: Paty
authors: Kathleen J
authors: KJ
authors: Ozsvath
authors: R Clement
authors: RC
authors: Darling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005548:Foreign-Body Migration / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome