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Sealing technique feasible for treatment of acute AAA
Results of a small retrospective, observational study indicate that a novel endovascular aneurysm sealing technique is a safe and feasible treatment for acute abdominal aortic aneurysms.
Researchers evaluated use of an endovascular aneurysm sealing (EVAS) technique (Nellix, Endologix) among 58 patients with acute abdominal aortic aneurysms (AAAs) treated at eight centers in Europe and New Zealand between February 2013 and April 2015. The cohort included 28 patients with ruptured aneurysms and 30 with symptomatic aneurysms. The mean age of the cohort was 74 years and 46 were men. The mean maximum aneurysm diameter at baseline was 74.7 mm in the ruptured group and 65.8 mm in the symptomatic group (P = .03).
The primary endpoint was mortality rate at 30 days. Other endpoints included endoleak, reintervention and 30-day morbidity. Follow-up was conducted for a mean of 9.3 months among patients with ruptured aneurysms and 12.4 months among those with symptomatic aneurysms.
Mean aneurysm diameter decreased from baseline to 71.8 mm in the ruptured group and increased to 66.1 mm in the symptomatic group. The 30-day mortality rate was 32% among patients with ruptured aneurysms and 7% among those with symptomatic aneurysms (P = .011); morbidity rates were 57% and 17%, respectively (P = .001).
Postoperative complications were more common in the ruptured group compared with the symptomatic group (57% of patients vs. 17%; P = .001). Two patients, one from each group, experienced early endoleak. Eight patients in the ruptured group required reinterventions within 30 days, whereas the only reintervention in the symptomatic group at 30 days was performed for the patient who developed a type Ia endoleak. A second patient in the symptomatic group later required reintervention during follow-up after developing bilateral type Ib endoleaks.
The researchers noted that patients in the symptomatic group had a shorter ICU stay compared with the ruptured group (mean, 0.8 days vs. 4 days; P = .002). Blood transfusion also was necessary during hospitalization for more patients in the ruptured group (69% vs. 10%; P < .001).
“EVAS in the acute setting appears safe and feasible and concordant with the literature for endovascular aneurysm repair,” the researchers concluded. However, they also wrote that the results “should be considered with care,” as all participating physicians had experience in elective EVAS treatment and that there was a high potential for selection bias.
“Obviously, more robust prospective data and, eventually, comparative trials with [endovascular aneurysm repair] are required before considering the technique standard of care,” they wrote. “Treatment protocols and bailout strategies are still in development.” – by Adam Taliercio
Disclosure: Several researchers report consulting for and serving as members of the scientific advisory board for Endologix.