Analysis of Outcomes After Endovascular Abdominal Aortic Aneurysm Repair in Patients With Abnormal Findings on the First Postoperative Computed Tomography Angiography. (December 2021)

• Record Type: Journal Article
• Authors: Geraedts, Anna C. M.; Mulay, Sana; van Dieren, Susan; Koelemay, Mark J. W.; Balm, Ron
• Other Names: Balm R. non-byline-author.; Elshof J. W. non-byline-author.; Elsman B. H. P. non-byline-author.; Hamming J. F. non-byline-author.; Koelemay M. J. W. non-byline-author.; Kropman R. H. J. non-byline-author.; Poyck P. P. non-byline-author.; Schurink G. W. H. non-byline-author.; de Smet A. A. E. A non-byline-author.; van Sterkenburg S. M. non-byline-author.; Ünlü C. non-byline-author.; Vahl A. C. non-byline-author.; Verhagen H. J. M. non-byline-author.; Vriens P. W. H. E. non-byline-author.; de Vries J. P. P. M. non-byline-author.; Wever J. J. non-byline-author.; Wisselink W. non-byline-author.; Zeebregts C. J. non-byline-author.
• Is Part Of: Journal of endovascular therapy. Volume 28:Number 6(2021)
• Page Start: 878
• Page End: 887
• Publication Date: 2021-12
• Subjects: abdominal aortic aneurysm -- endovascular aneurysm repair -- postoperative complication -- reintervention; Blood-vessels -- Endoscopic surgery -- Periodicals; Angioscopy -- Periodicals; Intravenous catheterization -- Periodicals; Peripheral vascular diseases -- Treatment -- Periodicals; Vascular Surgical Procedures -- Periodicals; Angioscopy -- Periodicals; Catheterization, Peripheral -- Periodicals; Peripheral Vascular Diseases -- therapy -- Periodicals; Angioscopie; Maladies vasculaires périphériques; 617.413
• DOI: 10.1177/15266028211030539
• Languages: English
• ISSNs: 1526-6028

Abstract

Purpose: Lifelong follow-up after endovascular abdominal aortic aneurysm repair (EVAR) is recommended due to a continued risk of complications, especially if the first postoperative imaging shows abnormal findings. We studied the long-term outcomes in patients with abnormalities on the first postoperative computed tomography angiography (CTA) following EVAR. Materials and Methods: This is a retrospective study of all consecutive patients who underwent elective EVAR for nonruptured abdominal aortic aneurysm (AAA) between January 2007 and January 2012 in 16 Dutch hospitals with follow-up until December 2018. Patients were included if the first postoperative CTA showed one of the following abnormal findings: endoleak type I–IV, endograft kinking, infection, or limb occlusion. AAA diameter, complications, and secondary interventions during follow-up were registered. Primary endpoint was overall survival, and other endpoints were secondary interventions and intervention-free survival. Kaplan-Meier analyses were used to estimate overall and intervention-free survival. Cox regression analyses were used to identify the association of independent determinants with survival and secondary interventions. Results: A total of 502 patients had abnormal findings on the first postoperative CTA after EVAR and had a median follow-up (interquartile range IQR) of 83.0 months (59.0). The estimated overall survival rate at 1, 5, and 10 years was 84.7%, 51.0%, and 30.8%, respectively. Age [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.05 to 1.10] and American Society of Anesthesiologists (ASA) classification (ASA IV HR 3.20, 95% CI 1.99 to 5.15) were significantly associated with all-cause mortality. Overall, 167 of the 502 patients (33.3%) underwent 238 secondary interventions in total. Fifty-eight patients (12%) underwent an intervention based on a finding on the first postoperative CTA. Overall survival was 38.4% for patients with secondary interventions and 44.5% for patients without (log rank; p=0.166). The intervention-free survival rate at 1, 5, and 10 years was 82.9%, 61.3%, and 45.6%, respectively. Conclusions: Patients with abnormalities on the first postoperative CTA after elective EVAR for infrarenal AAA cannot be discharged from regular imaging follow-up due to a high risk of secondary interventions. Patients who had a secondary intervention had similar overall survival as those without secondary interventions.