Abstract

RODRIGUES, Gonçalo Manuel et al. Endovascular treatment of abdominal aortic aneurysms in patients with challenging anatomy: short and mid-term institucional results. Angiol Cir Vasc [online]. 2015, vol.11, n.3, pp.158-165. ISSN 1646-706X.

Background: The goal of this study is to determine the influence of abdominal aortic aneurysm (AAA) anatomy in endovascular aneurysm repair (EVAR) short and mid-term outcomes. Methods: A total of 112 patients underwent programed aorto-biiliac EVAR at a single center between January 2011 and December 2013. Pre and postoperative imaging follow-up were retrospectively reviewed and anatomical measures were calculated on Osirix® with center lumen line. Only patients with a postoperative imaging follow-up of more than 12 months were included, resulting in the exclusion of thirty three (29%) cases. Patients were divided into 2 groups: the ‘‘EVAR suitable anatomy'' group (f-IFU) and the ‘‘EVAR challenging anatomy'' group (df-IFU). Results: A total of 35.5% (n = 28) patients were in the df-IFU group. These patients had larger AAA diameter (64.4 ± 10.1 mm vs 60.6 ± 10.8 mm) and shorter proximal neck (19.8 ± 11.8 mm vs 30.4 ± 14.4 mm) (p < 0.05). The device preferentially used was Endurant® (54,5%). The df-IFU group was more likely to be treated with suprarenal fixation devices (85.7% df-IFU vs 69% f-IFU, p = .048). Mean follow-up was 21,9 ± 9,8 months (12-46). Perioperative mortality (0% df-IFU vs 2% f-IFU) and all-cause mortality rates (12% df-IFU vs 11,9% f-IFU) were similar between the two groups (p > 0.05). There was no significant difference in endoleak rate (short-term 25% df-IFU vs 22% f-IFU; mid-term 12% df-IFU vs 23.8% f-IFU) and in re-intervention rates (short-term 7.2% df-IFU vs 8% f-IFU; mid-term 4% df-IFU vs 4.8% f-IFU)(p > 0.05). Conclusion: Endovascular treatment of AAA patients with challenging anatomy for EVAR provided acceptable short and mid-term results that are comparable to those in patients with suitable anatomy. Long-term follow-up is unreliable necessary to confirm these results.

Keywords : Abdominal aortic aneurysm; Endovascular aneurysm repair; Instuctions for use; Challenging anatomy; Endoleak; Re-intervention.

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