title: Sealing zones have a greater influence than iliac anatomy on the occurrence of limb occlusion following endovascular aortic aneurysm repair.
abstract: Limb occlusion is a well-known complication following endovascular aortic aneurysm repair (EVAR), and it very often leads to reoperation. The aim of this study is to identify predictive factors for limb occlusion following EVAR. Two hundred and twenty-four patients undergoing EVAR between 2004 and 2012 were included in this retrospective study. Demographics, anatomic, and follow-up data were compared between two groups (with or without thrombosis). Preoperative anatomy was analyzed with a dedicated workstation, using the Society of Vascular Surgery reporting standards. Eleven (4.9%) patients presented with a limb occlusion during follow-up (46 ± 12 months). Univariate analyses were first performed to investigate the influence of preoperative variables on limb occlusion. Then, variables with a p value <0.1 were included in the multivariate analysis and showed that in the occlusion group there was a greater rate of chronic renal failure (18.2% vs. 3.8%, p = 0.012), a more frequent occurrence of distal landing zones in the external iliac artery (15.4% vs. 2.1%, p = 0.006), and a smaller aortic neck diameter (21.0 ± 2.9 mm vs. 23.6 ± 3.3 mm, p = 0.014). Although iliac anatomy does not appear to have a significant influence on limb occlusion rate in the multivariate analysis, proximal and distal sealing zones appear to be involved in this complication.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France INSERM, Rennes, France Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Daoudal
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cardon
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France INSERM, Rennes, France Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Clochard
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France INSERM, Rennes, France Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lucas
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France INSERM, Rennes, France Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France kaladrien@hotmail.fr.
authors.forename: Adrien
authors.initials: A
authors.lastname: Kaladji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Limb occlusion; complication; endovascular aortic aneurysm repair; reoperation; thrombosis