Abstract
Introduction
Endovascular repair (EVAR) for large abdominal aortic aneurysm (AAA) in anatomically suitable patients is associated with low early mortality and morbidity. However, EVAR is associated with a significant risk of late complication and a high cumulative re-intervention rate. Many large experienced centres have offered complex EVAR to challenging aortic anatomies such as abdominal aorto-iliac aneurysm (AAIA). We hypothesised that complex EVAR, for AAIA, would be associated with an increased risk of late graft-related complications.
Methods
The design was a Retrospective Clinical Cohort Study. From a prospective computerised database we identified consecutive patients undergoing EVAR in a single institution between 2008 and 2009. We retrieved analysis clinical data and digital Computed Tomographic Angiography (CTA) scans carried out pre-, early post-, and late post-EVAR. We compared patients undergoing complex EVAR for AAIA with those undergoing conventional standard EVAR for AAA.
Results
We identified 93 consecutive patients undergoing EVAR, 13 patients were excluded (3 eEVAR, 1 TEVAR, 9 data could not be retrieved) leaving 80 patients for analysis, 63 male and 17 female, average age 74.5 years (range 57–86), average follow-up 38 months (range 27–50), primary EVAR success was 100 % and there was no mortality. Complex EVAR, EVAR plus internal iliac artery embolisation (+IIAE) and extension of the ipsilateral graft limb to the external iliac artery, for AAIA were carried out in 19/80 patients. After standard EVAR, late post-EVAR AAA sac diameter was significantly reduced in EVAR (63.24 ± 9.76 vs 54.26 ± 13.70, p < 0.001) but not after complex EVAR+IIAE (58.89 ± 16.39 vs 52.35 ± 12.75, p = 0.62). Endoleak these were significantly more common in the complex EVAR+IIAE, 5/19 (26.32 %), as compared to the standard EVAR, 11/61 (18.03 %), p < 0.01. Interestingly, inferior mesenteric artery (IMA) Patency was much commoner after complex EVAR+IIAE (15/19, 78.95 %) compared EVAR (29/61, 47.54 %), p < 0.01.
Conclusion
EVAR can be carried out with low early mortality but has a significant risk of late complication, the commonest of which is endoleak. Complex EVAR for abdominal aorto-iliac aneurysm can be carried out with comparable results to conventional EVAR. However, high rates of persistent endoleak and inferior mesenteric artery patency, and lack of aneurysm sac shrinkage, would suggest they may be at increased risk of late complications and may benefit from enhanced and extended radiological surveillance.
Similar content being viewed by others
References
Rap S (2002) The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 360(9345):1531–1539
The United Kingdom EVAR Trial Investigators (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362(20):1863–1871
Schanzer A, Greenberg RK, Hevelone N, Robinson WP, Eslami MH, Goldberg RJ, Messina L (2011) Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair/clinical perspective. Circulation 123(24):2848–2855
Georgakarakos E, Georgiadis GS, Ioannou CV, Kapoulas KC, Trellopoulos G, Lazarides M (2012) Aneurysm sac shrinkage after endovascular treatment of the aorta: beyond sac pressure and endoleaks. Vasc Med 17(2):156–162
Schoder M, Zaunbauer L, Holzenbein T, Fleischmann D, Cejna M, Kretschmer G, Thurnher S, Lammer J (2001) Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: frequency, efficacy, and clinical results. AJR Am J Roentgenol 177(3):599–605
van Marrewijk C, Buth J, Harris PL, Norgren L, Nevelsteen A, Wyatt MG (2002) Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: the EUROSTAR experience. J Vasc Surg 35(3):461–473
Farner MC, Carpenter JP, Baum RA, Fairman RM (2003) Early changes in abdominal aortic aneurysm diameter after endovascular repair. J Vasc Int Radiol JVIR 14(2 Pt 1):205–210
Thakor AS, Winterbottom A, Mercuri M, Cousins C, Gaunt ME (2011) The radiation burden from increasingly complex endovascular aortic aneurysm repair. Insights Imaging 2(6):699–704
AbuRahma AF, Campbell JE, Mousa AY, Hass SM, Stone PA, Jain A, Nanjundappa A, Dean LS, Keiffer T, Habib J (2011) Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J Vasc Surg Off Publ Soc Vasc Surg Int Soc Cardiovasc Surg N Am Chapter 54(1):13–21
Falkensammer J, Hakaim AG, Oldenburg WA, Neuhauser B, Paz-Fumagalli R, McKinney JM, Hugl B, Biebl M, Klocker J (2007) Natural History of the iliac arteries after endovascular abdominal aortic aneurysm repair and suitability of ectatic iliac arteries as a distal sealing zone. J Endovasc Ther 14(5):619–624
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Blair, R., Collins, A. & Harkin, D.W. Complex EVAR for abdominal aorto-iliac aneurysm (AAIA) is associated with high rate of endoleak and less aortic sac shrinkage compared to conventional EVAR for AAA. Ir J Med Sci 184, 871–875 (2015). https://doi.org/10.1007/s11845-014-1210-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-014-1210-4