AAA stent graft tied to durable performance, low 10-year rates of aneurysm-related death
Key takeaways:
- In patients who received a stent graft for endovascular abdominal aortic aneurysm repair, rates of aneurysm-related death were low.
- Most patients did not require reintervention over 10 years.
A stent graft for abdominal aortic aneurysm repair was associated with durable performance and low rates of aneurysm-related mortality at 10 years, researchers reported at the Charing Cross Symposium.
As Healio previously reported, the ENGAGE registry was a real-world study of more than 1,200 patients who underwent endovascular aneurysm repair with the stent graft (Endurant, Medtronic). Final 10-year results of the extended follow-up cohort of 390 patients were presented at Charing Cross by Hence J.M. Verhagen, MD, PhD, professor and chief of vascular surgery at Erasmus University Medical Center in Rotterdam, the Netherlands.
Compared with the patients not in it, those who were in the extended follow-up cohort were younger (70 years vs. 74 years; P < .001), less likely to be female (7.7% vs. 11.8%; P = .028) and less likely to have cardiac disease, pulmonary disease, renal insufficiency, cerebral vascular accident or peripheral disease, according to the researchers.
“The original randomized controlled trials raised concern for the long-term durability of EVAR,” Verhagen said during a presentation. “Ten-year data comparing contemporary EVAR devices and open surgical repair tell a different story.”
Among the 390 patients from the extended follow-up cohort plus 75 who were from sites participating in the extended follow-up cohort but who died before reconsenting, the 10-year rate of freedom from all-cause mortality was 42.8%, Verhagen said.
However, in the extended cohort, the rate of freedom from aneurysm-related mortality was 94.7%, he said.
The rate of freedom from aneurysm-related intervention at 10 years was 70.3%, “with no decline at longer follow-up,” Verhagen said during the presentation.
There were 72 late reinterventions, defined as occurring between 6 and 10 years, and almost all were due to endoleaks, likely reflecting aneurysm disease progression, as opposed to graft occlusion, he said.
In addition, 43% of patients with type Ia endoleaks had a wide proximal neck, a short proximal neck and/or oversizing by 10% or less, Verhagen said, noting that late aneurysm rupture occurred in 12 patients, all of whom had an endoleak.
He also said 68 patients had a sac increase between 6 and 10 years, but the rest had sac regression.
“The ENGAGE registry reveals unique 10-year data and confirms the long-term efficacy and durability of the Endurant stent graft,” Verhagen said during the presentation. “The most frequent causes for late adverse events are initial hostile anatomy and progression of aneurysm disease. Lifelong surveillance is critical for EVAR patients.”
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Verhagen HJM, et al. Day 2 Morning: Abdominal Aortic. Presented at: Charing Cross Symposium; April 25-27, 2023; London.
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