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Long-term Outcomes From Two Decades Of Endovascular Aortic Repair
Suma Gondi, BS1, Shaminy Manoranjithan, BS
1, Chase Schlesselman, MPH
1, Steven Cheung, MD
2, Todd R. Vogel, MD MPH
1, Jonathan Bath
1.
1University of Missouri, Columbia, MO, USA,
2University of Missouri, COLUMBIA, MO, USA.
OBJECTIVES: Endovascular aortic repair (EVAR) approaches its third decade of commercial use. We sought to evaluate our experience with EVAR over the past two decades.
METHODS: Patients (2000-2022) undergoing EVAR were identified at an academic institution. Chi-square, T-test and Kaplan-Meier (KM) analysis were used to evaluate outcomes.
RESULTS: 500 patients undergoing infrarenal EVAR were included with 397 men (79.4%) and 103 women (20.6%) with mean age of 71. Indication was aneurysm/pseudoaneurysm in 443 patients (88.6%), aortic dissection, thrombus, trauma and PAU/IMH in the remainder. 168 EVAR were performed for symptoms (33.6%). Thirty-day outcomes included stroke (0.8%), cardiac events (3.2%), mortality (4.4%) and endoleak (6.8%). Outcomes over 42.6 months mean follow-up included mortality (17.8%) and endoleak (8.2%). Reinterventions occurred in 7.2% and were mainly endovascular (5.4%) with open procedures in 1.8%. Compared to women, men had larger endografts placed (28 vs. 27 mm;p=0.03), larger iliac graft sizes (15.9 vs. 15.2 mm;p=0.07), fewer deaths (9.7 vs. 3%;p=0.003), less limb ischemia (3.9 vs. 0.8%;p=0.04) and fewer wound infections (7.8% vs. 3.3%;p=0.04) at thirty days. Overall, rates of endoleak and reintervention did not differ between sexes. Outcomes by symptomatic status revealed that MACE (5.4 vs. 2.1;p=0.05), mortality (8.9 vs. 2.1%;p=0.0004), pulmonary failure (5.9 vs. 1.2%;p=0.007), leg ischemia (3.6 vs. 0.3%;p=0.007) and other complications (15.5 vs. 8.1%;p=0.01) were associated with symptomatic patients. Outcomes by graft size revealed MACE (6.9 vs. 1.9%;p=0.007), renal failure (4.8 vs. 0.9%;p=0.01) and open reinterventions (2 vs. 0;p=0.03) were associated with larger (>28 mm) grafts. KM analysis demonstrated that mortality was significantly different between symptomatic patients (p=0.03) and those with larger (>28 mm) endografts (p=0.02) (Figure.1) at 60 months.
CONCLUSIONS: In this two-decade series of EVAR, excellent overall outcomes are seen with low mortality, reintervention rate as well as endoleak. There were differences in outcomes by gender and symptoms, however, patients with endografts with a diameter > 28 mm fared much worse than smaller sized endografts. This is suggestive that hostile neck aneurysms may be more malignant than those with normal neck morphology, portending poorer overall survival and outcome. Figure 1. Kaplan-Meier curve demonstrating mortality for endograft size p = 0.02
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