title: Ten-year results of endovascular abdominal aortic aneurysm repair from a large multicenter registry.
abstract: OBJECTIVE
  To assess outcomes after endovascular abdominal aortic aneurysm repair (EVAR) in an integrated health care system.
  
  
  METHODS
  Between 2000 and 2010, 1736 patients underwent EVAR at 17 centers. Demographic data, comorbidities, and outcomes of interest were collected. EVAR in patients presenting with ruptured or symptomatic aneurysms was categorized as urgent; otherwise, it was considered elective. Primary outcomes were mortality and aneurysm-related mortality (ARM). Secondary outcomes were change in aneurysm sac size, endoleak status, major adverse events, and reintervention.
  
  
  RESULTS
  Overall, the median age was 76 years (interquartile range, 70-81 years), 86% were male, and 82% were Caucasian. Most cases (93.8%) were elective, but urgent use of EVAR increased from 4% in the first 5 years to 7.3% in the last 5 years of the study period. Mean aneurysm size was 5.8 cm. Patients were followed for an average of 3 years (range, 1-11 years); 8% were lost to follow-up. Intraoperatively, 4.5% of patients required adjunctive maneuvers for endoleak, fixation, or flow-limiting issues. The 30-day mortality rate was 1.2%, and the perioperative morbidity rate was 6.6%. Intraoperative type I and II endoleaks were uncommon (2.3% and 9.3%, respectively). Life-table analysis at 5 years demonstrated excellent overall survival (66%) and freedom from ARM (97%). Postoperative endoleak was seen in 30% of patients and was associated with an increase in sac size over time. Finally, the total reintervention rate was 15%, including 91 instances (5%) of revisional EVAR. The overall major adverse event rate was 7.9% and decreased significantly from 12.3% in the first 5 years to 5.6% in the second 5 years of the study period (P < .001). Overall ARM was worse in patients with postoperative endoleak (4.1% vs 1.8%; P < .01) or in those who underwent reintervention (7.6% vs 1.6%; P < .001).
  
  
  CONCLUSIONS
  Results from a contemporary EVAR registry in an integrated health care system demonstrate favorable perioperative outcomes and excellent clinical efficacy. However, postoperative endoleak and the need for reintervention continue to be challenging problems for patients after EVAR.
authors.affiliation: Permanente Medical Group, South San Francisco, CA, USA. robert.w.chang@kp.org
authors.forename: Robert W
authors.initials: RW
authors.lastname: Chang
authors.forename: Philip
authors.initials: P
authors.lastname: Goodney
authors.forename: Lue-Yen
authors.initials: LY
authors.lastname: Tucker
authors.forename: Steven
authors.initials: S
authors.lastname: Okuhn
authors.forename: Hong
authors.initials: H
authors.lastname: Hua
authors.forename: Ann
authors.initials: A
authors.lastname: Rhoades
authors.forename: Nayan
authors.initials: N
authors.lastname: Sivamurthy
authors.forename: Bradley
authors.initials: B
authors.lastname: Hill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002140:California; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D004630:Emergencies; D057867:Endoleak / Q000209:etiology / Q000401:mortality / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D015993:Life Tables; D008297:Male; D008329:Managed Care Programs; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome