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Anatomic Severity Grade Scores Predicts Reinterventions After Endovascular Aortic Repair
Patricia G. Johnson, BS, Candice R. Chipman, MD, Samuel Steerman, MD, Jonathan A. Higgins, MBBS, Sadaf S. Ahanchi, MD, Jean M. Panneton, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
Background
Our objective was to look at our experience with reintervention after endovascular aortic repair (EVAR) in relation to the anatomic severity grading (ASG) score, a quantification of abdominal aortic aneurysm (AAA) anatomic complexity developed by the Society of Vascular Surgery in 2002.
Methods
This is a retrospective review of AAA patients treated with EVAR from January 2007 through December 2011. All data was collected using paper and electronic medical records. ASG component scores (neck, aortic, and iliac) and total ASG scores were calculated using M2S software (M2S Inc, New Hampshire).
Results
The review yielded 623 EVAR patients, 79 of which had a reintervention (13% reintervention rate). There were 20 females (25%) and 59 males (75%) with an average age of 75 ±9 and presented electively (63, 80%), urgently (11, 14%), and emergently (5, 6%). The number of reinterventions per patient ranged from 1 to 5 (mean of 2 ±1). Reinterventions were required at a mean of 12 ±35 months from the index procedure.
The most frequent reinterventions included proximal extension cuff (30, 38%), type II endoleak embolization (16, 20%), open conversion (12, 15%), limb thrombectomy (11, 14%), transluminal angioplasty plus stenting (10, 13%), distal extension cuff (10, 13%), and relining of endograft (8, 10%). Twenty nine patients (36.7%) had various combinations of the above procedures.
Of the 79 total reintervention patients, 45 had preoperative M2S 3-D reconstructions of their aneurysms. The average total ASG score from highest to lowest of the reintervention categories were then calculated. ASG scores range from 8 to 30 with a mean of 18. Proximal extension cuff, distal extension cuff, and open conversion all had a mean ASG score of 19. Embolization of type II endoleak and limb thrombectomy both had a mean ASG score of 18. Lastly, relining of an endograft had a mean ASG score of 16. The mean neck, aorta, and iliac scores of proximal extension cuffs were 3, 8, and 8 versus 3, 7, and 9 for distal extension cuffs.
Conclusion
Analysis of our experience showed higher total ASG score and ASG component scores with various reinterventions. Preoperative ASG scores could offer vascular surgeons a way to better inform their patients of the risks associated with their EVAR.
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