title: Composite stent-grafts are not associated with increased endoleak or reintervention rates after endovascular abdominal aneurysm repair.
abstract: BACKGROUND
  Although present-generation endografts have expanded the indications for endovascular abdominal aneurysm repair, arterial anatomy frequently dictates the use of a combination of commercially available endografts and components for successful aneurysm repair. This study sought to determine whether there was an increase in endoleak or secondary intervention rates in individuals treated with composite endografts compared with noncomposite, or standard, endografts.
  
  
  METHODS
  From 1999 to 2009, 421 endovascular abdominal aneurysm repairs were performed at a single institution. A total of 384 patients met criteria for inclusion, with at least one follow-up imaging study. Patients were then identified as having had a composite endograft, defined as any combination of two or more different commercially available endograft or stent components, versus a standard endograft. Primary outcomes measured were freedom from endoleak and secondary intervention.
  
  
  RESULTS
  During the study period, 60 composite endograftings and 324 standard endograftings were performed. The groups were well matched for demographics, including age, gender, comorbidities, emergent need for procedure, and 30-day mortality (1.64% vs. 1.54%, nonsignificant). Median follow-up was 16.3 months (range, 19 days to 8.5 years) and 10.2 months (range, 4 days to 8.7 years) for composite and standard endografts, respectively. There was no significant difference between the groups in either endoleak or secondary intervention rates. Median time to endoleak detection was 2.0 months (range, 2 days to 3.9 years) for composite endografts and 2.8 months (range, 2 days to 6.9 years) for standard endografts. Median time to secondary intervention was 7.0 months (range, 4 days to 6.9 years) for composite endografts and 6.7 months (range, 1 day to 6.7 years) for standard endografts.
  
  
  CONCLUSIONS
  Composite endografts, namely, the combination of different commercially available endografts or stents used for the treatment of aortic aneurysms, are not associated with increased mortality, endoleak, or secondary intervention rates compared with noncomposite endografts.
authors.affiliation: The Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109-5876, USA.
authors.forename: Julia T
authors.initials: JT
authors.lastname: Saraidaridis
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Osborne
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.forename: Enrique
authors.initials: E
authors.lastname: Criado
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.forename: Narasimham L
authors.initials: NL
authors.lastname: Dasika
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D057867:Endoleak / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome