title: Results of reinterventions for failed endovascular aortic repair: a single-center experience.
abstract: OBJECTIVE
  The aim of this paper was to review technical success and clinical outcome of reinterventions to treat complications after endovascular abdominal aortic aneurysm (AAA) repair (EVAR) in a tertiary vascular center.
  
  
  METHODS
  The study enrolled 107 patients treated for post-EVAR complications between January 2005 and March 2014. Details of reinterventions, technical success, and midterm clinical outcome were analyzed for reinterventions. Radiologic follow-up after reinterventions was performed by computed tomography scans and duplex ultrasonography.
  
  
  RESULTS
  Indications for reinterventions in the 107 patients were predominantly endoleaks type Ia, Ib, II, and III (55.1%). Endograft obstructions were observed in 39 patients (36.4%). The initial technical success rate for the 107 reinterventions was 93.5% (N.=100). Median follow-up postreintervention was 20 months (range, 1-107 months). During follow-up, 34 of 107 patients (31.8%) needed at least one renewed reintervention. Kaplan-Meier analysis of overall survival after the primary reinterventions was 85% at 1 year, and 78% at 3 years of follow-up. AAA/EVAR-associated mortality was 4% at 3 years. Kaplan-Meier survival estimation of freedom of recurrence was 88% at 1 year post-reintervention and 78% at 3 years. Renewed reintervention-free survival dropped to 78% at 1 year and 58% at 3 years.
  
  
  CONCLUSIONS
  In this series of patients, the technical success rate of reinterventions to treat post-EVAR complications was high. During a median follow-up of 20 months, AAA-associated mortality is low, but the need for renewed (endovascular) reinterventions is substantial.
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands - j.vries@antoniusziekenhuis.nl.
authors.forename: C J G
authors.initials: CJ
authors.lastname: Wijffels
authors.forename: G W
authors.initials: GW
authors.lastname: Van Lammeren
authors.forename: E J
authors.initials: EJ
authors.lastname: Waasdorp
authors.forename: J
authors.initials: J
authors.lastname: Wille
authors.forename: D A B
authors.initials: DA
authors.lastname: Werson
authors.forename: D A F
authors.initials: DA
authors.lastname: Van Den Heuvel
authors.forename: J P
authors.initials: JP
authors.lastname: De Vries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D020878:Device Removal; D018572:Disease-Free Survival; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009426:Netherlands; D011237:Predictive Value of Tests; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex