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Aneurysm anatomy appears to affect outcomes after EVAR for ruptured AAA
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Aneurysm anatomy is linked to long-term mortality and complications in patients receiving endovascular aneurysm repair for ruptured abdominal aortic aneurysms, according to results published in the Journal of Endovascular Therapy.
Researchers analyzed data from 112 patients (mean age, 73 years; 102 men) treated for ruptured abdominal aortic aneurysms (AAA) at two hospitals in Sweden and one in the Netherlands from 2000 to 2010. Patients were stratified by aortic anatomy and whether endovascular aneurysm repair (EVAR) was performed inside or outside the instructions for use (IFU). The median follow-up for patients surviving 30 days was 2.5 years.
Of that cohort, 61 patients (54%) were treated inside the IFU and 43 (38%) outside the IFU. Eight patients were disqualified due to a lack of adequate preoperative CT scans. Eighty-six patients (77%) displayed one or more preoperative comorbidities.
Graft-related complications occurred in 6% (95% CI, 0-13) of patients treated inside the IFU vs. 30% (95% CI, 14-42) outside the IFU. The rate of graft-related secondary interventions was 14% (95% CI, 4-22) for those treated inside the IFU vs. 35% (95% CI, 14-42) outside.
Patients treated outside the IFU had larger aneurysms (83.9 mm vs. 74.6 mm, P = .017) than those inside the IFU, as well as a higher frequency of peripheral artery disease (6 vs. 1, P = .016).
In a multivariable analysis, neck length less than 15 mm (HR = 8.1; 95% CI, 3-21.9) and angulation greater than 60° (HR = 3.1; 95% CI, 1-9.3) were independent predictors of late graft-related complications, whereas aneurysm neck diameter greater than 29 mm (HR = 2.5; 95% CI, 1.1-5.9) was an independent predictor of overall mortality.
Mortality at 30 days was 15% (95% CI, 6-24) for those inside the IFU and 30% (95% CI, 16-45) outside (P = .087). Three-year mortality estimates were 33.8% (95% CI, 20-47.5) for those inside the IFU vs. 56% (95% CI, 39.7-72.2) outside (P = .016). At 5 years, mortality was 48% (95% CI, 30-66) for patients inside the IFU and 74% (95% CI, 54-93) outside (P = .015).
“The role of endovascular techniques in the treatment of patients with complex aortic anatomy and infrarenal AAA rupture needs to be further studied to assess the role of adjunct endovascular techniques and to compare results to open repair in anatomically challenging cases,” the researchers wrote. “Surveillance programs should be adjusted for early detection of complications if [EVAR for ruptured AAA] is performed on patients with aortic anatomy outside the IFU.” – by James Clark
Disclosure: The researchers report no relevant financial disclosures.
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