title: Reinterventions following endovascular abdominal aortic aneurysm repair: the learning curve of time.
abstract: OBJECTIVE
  The DREAM and EVAR-1 trial show a higher reintervention rate after endovascular aneurysm repair (EVAR) compared to open repair. Since the initiation of these trials, endovascular-graft design and the experiences with EVAR have evolved substantially. The aim of this study was to compare the need for reinterventions in our recent EVAR procedures with our early procedures.
  
  
  METHODS
  A retrospective review of our prospectively maintained database of all patients undergoing an elective EVAR for infrarenal abdominal aortic aneurysm (AAA) was performed. The 68 patients treated between 2000 and 2006 were defined as the "Early EVAR" group; the 41 patients treated between 2006 and 2008 were defined as the "Recent EVAR" group. The median follow-up was 63.3 (range 2-111) and 43.7 (range 1-61) months in the Early and Recent EVAR group respectively.
  
  
  RESULTS
  Treatment related mortality occurred in three (4.4%) patients in the Early EVAR group. No treatment related mortality occurred in the Recent EVAR group. In the Early EVAR group 16 reinterventions occurred in 13 patients (19.1%) and in the Recent EVAR group three reinterventions occurred in three patients (7.5%). This difference was statistically significant (P=0.039).
  
  
  CONCLUSIONS
  In our center, continued experiences with EVAR, improvement of graft design and a different management of complications have led to a significant decrease in reinterventions after EVAR. These findings and a review of the literature suggests that current need for reintervention after EVAR is substantially less than reported in the early trials.
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: E G
authors.initials: EG
authors.lastname: Klompenhouwer
authors.forename: J N
authors.initials: JN
authors.lastname: Helleman
authors.forename: G P J
authors.initials: GP
authors.lastname: Geenen
authors.forename: G H
authors.initials: GH
authors.lastname: Ho
authors.forename: L D
authors.initials: LD
authors.lastname: Vos
authors.forename: L
authors.initials: L
authors.lastname: Van Der Laan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies