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Patients with Familial Abdominal Aortic Aneurysms are at Increased Risk for Type 1 Endoleak Following Elective Endovascular Aneurysm Repair
Biju K. Thomas, M.D., Evan J. Ryer, M.D., Robert P. Garvin, M.D., Helena Kuivaniemi, M.D., Ph.D., David P. Franklin, M.D., James R. Elmore, M.D..
Geisinger Medical Center, Danville, PA, USA.

OBJECTIVES: A recent investigation has documented increased aneurysm related complications after endovascular aneurysm repair (EVAR) of familial abdominal aortic aneurysms (fAAA). We hypothesized that fAAA patients are not at increased risk following EVAR, when compared to EVAR for sporadic abdominal aortic aneurysms (spAAA). To this end, we performed a retrospective review of our single institution series. 

METHODS: Epidemiologic data was collected through the electronic medical record. Major adverse events were defined as myocardial infarction, cardiac arrest, respiratory failure requiring tracheostomy, renal failure requiring dialysis, colonic ischemia requiring resection, limb ischemia requiring amputation, multi-system organ failure or death. Endoleaks were classified in accordance with the standardized reporting practices of the Society for Vascular Surgery. 

RESULTS: Three hundred ninety one patients with complete family history and clinical data underwent elective AAA repair from 2004 to 2014. Demographics were consistent with a standard AAA population and did not differ between fAAA and spAAA patients. Sixty two percent (n=56) of fAAA patients and 68% (n=203) of spAAA patients underwent EVAR (p=0.31). fAAA patients did not incur any greater risk of major adverse events following EVAR (fAAA: 11% vs. spAAA: 9%, p=0.8) or open AAA repair (fAAA: 11% vs. 15%, p=0.78). Despite no difference in major morbidity, fAAA patients did have an increased rate of all type endoleaks (fAAA: 23% vs. spAAA: 12%, p=0.05). Furthermore, the rate of type 1 endoleak and subsequent re-intervention for type 1 endoleak did differ between the groups (fAAA: 7% vs. spAAA: 1%, p=0.02). In contrast, re-intervention for all types of endoleak following EVAR (fAAA: 13% vs. spAAA: 8%, p=0.16) did not differ between fAAA and spAAA patients. 

CONCLUSIONS: The current study demonstrates that patients with a familial form of AAA do not have increased morbidity following AAA repair but are more prone to endoleak following EVAR. We believe our results, combined with those of others, suggest EVAR for fAAA is safe and effective but represents a subpopulation that would benefit from close post-procedure surveillance.

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