Sac regression predicts survival after EVAR
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Among patients who had endovascular aneurysm repair, sac regression at 1 year was associated with lower risk for all-cause mortality at 5 years, according to new data from the ENGAGE registry.
“Sac regression should be the new paradigm of success after EVAR,” Dittmar Böckler, MD, professor and chair of the department of vascular and endovascular surgery at Heidelberg University in Germany, said during a presentation at ESVS Month, an event of the European Society for Vascular Surgery. “Follow-up adherence, especially within the first year, is a high priority to achieve early sac regression.”
Böckler and colleagues analyzed 949 patients from the ENGAGE registry who underwent EVAR from 2009 to 2011 and had abdominal aortic aneurysm measurements taken at 1 month and 1 year.
Patients were stratified by whether their sac decreased (decline of at least 5 mm; 46.5%), remained stable (change of less than 5 mm; 48.7%) or increased (rise of at least 5 mm; 4.8%) at 1 year. Compared with those whose sac increased, those whose sac decreased were younger (72 years vs. 75 years), had a lower AAA diameter (60.6 mm vs. 66.9 mm), were less likely to have a thoracic aortic aneurysm (1.7% vs. 8.7%) and had a shorter ICU stay (6.4 hours vs. 15.5 hours; P < .05 for all), according to the researchers.
At 5 years, 80% of the decreased group survived compared with 71.9% of the stable group and 62.6% of the increased group (P for decreased vs. stable = .007; P for decreased vs. increased = .01), Böckler said.
In a multiple Cox regression analysis, sac increase (HR = 1.912; P = .0234) was an independent predictor for 5-year mortality after EVAR, and sac stability (HR = 1.328; P = .0618) was close to being one, he said. Other predictors included age (HR = 1.053; P < .001), history of cancer (HR = 1.711; P = .0011), pulmonary disease (HR = 1.647; P = .0012) and congestive HF (HR = 2.014; P = .0051).
The decreased group also had higher rates of freedom from adverse events at 5 years compared with the stable group (75.7% vs. 60%; P = .007) and the increased group (55.6%; P = .004), Böckler said.
The same was true for freedom from repeat endovascular procedures at 5 years (decreased, 89.8%; stable, 82.5%; P = .008; decreased, 89.8%; increased, 63.1%; P < .001) and freedom from endoleaks.
Sac regression at 1 year also increased the odds that sac regression would be maintained at 5 years, as 86% of those with sac regression at 1 year still had it at 5 years compared with 2% who had a sac increase at 5 years, Böckler said, noting that by contrast, among those with sac stability at 1 year, 18% had a sac increase at 5 years, and among those with sac increase at 1 year, 56% still had sac increase at 5 years and 36.9% required a secondary endovascular procedure.
He also said patients with valvular heart disease were less likely to have sac regression at 1 year compared with patients who did not (OR = 0.437; P = .0123).
“Sac regression at 1 year is likely to persist through 5 years and patients have better outcomes,” Böckler said. “Stable sacs are not as benign as once thought.”
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Böckler D, et al. Scientific session on AAA 1. Presented at: ESVS Month; Sept. 28-Oct. 22, 2020 (virtual meeting).
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