This article is more than 5 years old. Information may no longer be current.
ENGAGE: Endovascular abdominal aortic aneurysm repair safe in challenging patients
Click Here to Manage Email Alerts
Patients with challenging aortic neck anatomy benefited from endovascular abdominal aortic aneurysm repair, according to findings from the ENGAGE registry.
The researchers investigated patients with various neck morphologic features to compare perioperative and postoperative outcomes of endovascular repair of abdominal aortic aneurysms with a stent graft (Endurant, Medtronic).
The three levels of proximal aortic neck anatomy were defined as follows: regular, or a proximal neck of at least 15 mm combined with a suprarenal angulation (alpha) up to 45° and an infrarenal neck angulation (beta) up to 60°; intermediate, which included patients with a proximal neck of 10 mm to 15 mm combined with alpha up to 45° and beta up to 60° or with a proximal neck greater than 15 mm combined with alpha up to 60° and beta 60° to 75° or alpha 45° to 60° and beta up to 75°; and challenging patients, or those with infrarenal necks that exceeded at least one of the three defining factors.
The breakdown of the study population included 75.9% in the regular group, 15.5% in the intermediate group and 8.5% in the challenging group.
The abdominal aortic aneurysm diameter was 59.4 mm in the regular group and 65.2 mm in the challenging group (P < .001).
Technical success rates were 99.1% in the regular group, 99.5% in the intermediate group and 97.1% in the challenging group.
The 30-day mortality rate was 1.3% in the regular group compared with 0.5% for intermediate and 2.9% for challenging patients. Also at that time point, type I endoleaks were more common in the challenging group compared with the intermediate group (adjusted OR = 0.08; 95% CI, 0.01-0.7) and the regular group (adjusted OR = 0.15; 95% CI, 0.05-0.46).
Secondary interventions were similar across the three groups.
Although type III endoleak and stent graft occlusion, stenosis and migration rates were similar across the three groups, stent graft kinking occurred more frequently among the challenging patients than in the regular patients.
At 1 year, all-cause and abdominal aortic aneurysm-related mortality were the same in the three groups. No significant differences were reported at 1 year for type I and III endoleaks. However, 1-year stent graft stenosis occurred significantly more frequently in the challenging group than in the regular group.
“This real-world, global experience shows promising results and indicates that endovascular abdominal aortic aneurysm repair with the Endurant stent graft (Medtronic Vascular) is safe and effective in patients with challenging aortic neck anatomy,” the researchers concluded. – by Rob Volansky
Disclosure: The researchers report receiving contributions and research grants from Medtronic and proctoring for Medtronic AVE.
Click Here to Manage Email Alerts