title: The Long-term Durability of Intra-operatively Placed Palmaz Stents for the Treatment of Type Ia Endoleaks After EVAR of Abdominal Aortic Aneurysm.
abstract: OBJECTIVE
  The objective was to analyze the long-term durability of intra-operatively placed Palmaz stents for type Ia endoleaks, and the evolution of aneurysm neck morphology.
  
  
  METHODS
  This was a retrospective cohort study conducted at a tertiary referral centre. Patients treated between 1998 and 2012 were reviewed with regard to pre-, intra-, and post-operative data. Crude and relative survival estimates were calculated, with the latter referring only to patients with ≥ 3 months' follow-up.
  
  
  RESULTS
  In total, 125 patients were included (83 elective, 22 ruptures, 20 symptomatic). Nine patients died perioperatively (two elective, seven acute). Median follow-up was 43 months (range 15-72). Seven patients had late abdominal aortic aneurysm related deaths. There were 51 re-interventions (seven type Ia endoleak related). Five year crude primary, primary assisted, and secondary success rates were 55 ± 5%, 66 ± 5%, and 70 ± 5%, respectively. These crude rates were superior for elective patients (p = .008, p = .031, and p = .037, respectively), but the relative rates were not (p = .187, p = .640, p = .558, respectively). Primary and assisted freedom from type Ia endoleak 5 years post-operatively were 84 ± 4% and 89 ± 3%, respectively. These rates were superior in elective patients (p = .066 and p = .145, respectively), especially when relative rates were analysed (p = .025 and p = .063, respectively). The visceral aortic diameter increased significantly between the first and the last post-operative imaging in 15/91 (16%), 12/91 (13%), 34/91 (37%), and 30/91 (33%) patients at the levels of coeliac trunk, superior mesenteric artery, lowest renal artery, and 9 mm distal to lowest renal artery, respectively.
  
  
  CONCLUSIONS
  Intra-operatively placed Palmaz stents confer high long-term freedom from type Ia endoleak. Palmaz stents are an acceptable intra-operative bailout tool in the acute setting, but should not be used to extend elective infrarenal endovascular aneurysm repair to more demanding anatomies.
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Abdulrasak
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Resch
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Sonesson
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Holst
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Kristmundsson
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden. Electronic address: nuno.dias@med.lu.se.
authors.forename: N V
authors.initials: NV
authors.lastname: Dias
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057867:Endoleak / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D009333:Neck / Q000473:pathology; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents
keywords: Aortic neck anatomy; EVAR; Palmaz stent; Type Ia endoleak