Outcomes Of Endovascular Treatments And Graft Explant For Failed Evar
Saranya Sundaram, Marcelo Giarelli, Murray L. Shames, MD.
USF Health Morsani School of Medicine Division of Vascular Surgery, Tampa, FL, USA.
Outcomes of Alternative Treatments for Failed EVAR
Objective: A number of strategies exist for the management of failed EVAR. Treatment algorithms range from endovascular interventions to EVAR explant. The objective of this study was to evaluate the management and outcomes of endovascular treatment and explant of failed EVAR.
Methods: A retrospective analysis of our AAA database(2014-2019) identified 159 patients treated with endovascular salvage techniques (116) or graft explant (43) for failed EVAR. The cause of device failure, demographics, incidence of residual endoleak, reintervention, morbidity and mortality were compared between groups.
Results: The majority of patients were white (n=153 [96.2%]) males (n=140 [88%]), with a mean age of 78.77 +/- 9.22 years. Patients had a high prevalence of comorbid conditions including, HTN (83%) or any history of smoking (93%). The causes of EVAR failure included endoleak (n=136 [79%]) (Type I endoleak, (n=95 [75%]), type II (n=6 [5%]), type III (n=12 [10%]), or unknown source (n=13 [10%]), infection of endograft (n=16 [10%]), aneurysm rupture (n=11[7%]), graft occlusion (n=3 [2%]), and unexplained AAA sac growth (n=3 [2%]).
| Cuff (n=38) | Cuff + Snorkel/Chimney (n=35) | Cuff + Staple (n=14) | Reline (n=23) | Fenestrated (n=6) | Explant (n=43) | |
| Residual/recurrent endoleak | 13% | 20% | 21% | 9% | 0% | 0% |
| 30-day mortality (Elective) | 0% | 0% | 0% | 4% | 0% | 2% |
| 30-day mortality (Emergent) | 0% | 0% | 0% | 4% | 0% | 23% |
Conclusions: Multiple techniques are available for the management of failed EVAR with acceptable results. Endovascular techniques are associated with a lower mortality than graft explant but have a higher rate of residual or recurrent endoleaks. Graft explant for emergent interventions has a high mortality rate. Failed EVAR salvage should be tailored to the individual patient, etiology of the device failure and skill set of the provider.
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