ENDOVASCULAR ANEURYSM REPAIR FOR INTACT AND RUPTURED ABDOMINAL AORTIC ANEURYSMS: SHOULD WE EXPECT MORE COMPLICATIONS AFTER R-EVAR?

  • José Oliveira Pinto Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de São João; Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto
  • Joel Sousa Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de São João; Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto
  • João Rocha Neves Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de São João; Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto; Departamento de Anatomia, Faculdade de Medicina da Universidade do Porto
  • Adelino Leite-Moreira Departamento de Anatomia, Faculdade de Medicina da Universidade do Porto
  • Armando Mansilha Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de São João; Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto
Keywords: Ruptured Abdominal Aortic Aneurysms, Endovascular Aneurysm Repair, Outcomes

Abstract

Introduction: Endovascular Aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (r-AAA) has been increasingly advocated due to short term benefits. Survival after discharge seems to be similar between EVAR for rAAA (r-EVAR) and for elective patients (el-EVAR). Still, due to higher anatomical complexity more graft-related complications may arise in r-EVAR patients.

Methods: MEDLINE databases were searched to identify publications reporting on outcomes after r-EVAR and el-EVAR. Landmark EVAR randomized controlled trial results were used as comparison.

Results: After-discharge outcomes (other than mortality), were reported in 5 studies including 509 r-EVAR patients. A direct comparison between r-EVAR and el-EVAR patients was found in 2 studies, including 2895 patients (256 r-EVAR and 2653 el-EVAR). Type I endoleak rates ranged from 5.4-21% in r- EVAR and from 4.4-10% el-EVAR. Rates of secondary intervention in r-EVAR ranged between 16.7-76% and in el-EVAR from 11-27.7%. Five year rate of complications after r-EVAR inside instructions for use were 8.8% and reinterventions were 16.7%.

Conclusions: r-EVAR patients present higher rates of type I endoleaks and secondary interventions. However, when complying with IFU, aneurysm-related complications overlap to the el-EVAR patients. Surveillance strategies should be tailored according to the baseline anatomical complexity and early complications and not to the timing of repair.

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References

1. Katzen BT, Dake MD, MacLean AA, Wang DS. Endovascular
repair of abdominal and thoracic aortic aneurysms. Circulation
2005;112:1663-75.
2. Reimerink JJ, van der Laan MJ, Koelemay MJ, Balm R, Legemate
DA. Systematic review and meta-analysis of population-based
mortality from ruptured abdominal aortic aneurysm. The British
journal of surgery 2013;100:1405-13.
3. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG.
Comparison of endovascular aneurysm repair with open repair in
patients with abdominal aortic aneurysm (EVAR trial 1), 30-day
operative mortality results: randomised controlled trial. Lancet
(London, England) 2004;364:843-8.
4. Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following
endovascular vs open repair of abdominal aortic aneurysm:
a randomized trial. Jama 2009;302:1535-42.
5. Sousa J, Brandao D, Barreto P, Ferreira J, Almeida Lopes J, Mansilha
A. [Percutaneous Endovascular Aortic Repair with Local Anesthesia
- One Day Surgery]. Acta medica portuguesa 2016;29:381-8.
6. Mayer D, Aeschbacher S, Pfammatter T, et al. Complete replacement
of open repair for ruptured abdominal aortic aneurysms by
endovascular aneurysm repair: a two-center 14-year experience.
Annals of surgery 2012;256:688-95; discussion 95-6.
7. Veith FJ, Lachat M, Mayer D, et al. Collected world and single center
experience with endovascular treatment of ruptured abdominal
aortic aneurysms. Annals of surgery 2009;250:818-24.
8. Mani K, Bjorck M, Lundkvist J, Wanhainen A. Improved long-term
survival after abdominal aortic aneurysm repair. Circulation
2009;120:201-11.
9. Bastos Goncalves F, Ultee KH, Hoeks SE, Stolker RJ, Verhagen
HJ. Life expectancy and causes of death after repair of intact
and ruptured abdominal aortic aneurysms. Journal of vascular
surgery 2016;63:610-6.
10. Slater BJ, Harris EJ, Lee JT. Anatomic suitability of ruptured abdominal
aortic aneurysms for endovascular repair. Annals of vascular
surgery 2008;22:716-22.
11. Hinchliffe RJ, Alric P, Rose D, et al. Comparison of morphologic
features of intact and ruptured aneurysms of infrarenal abdominal
aorta. Journal of vascular surgery 2003;38:88-92.
12. Reimerink JJ, Hoornweg LL, Vahl AC, et al. Endovascular repair
versus open repair of ruptured abdominal aortic aneurysms:
a multicenter randomized controlled trial. Annals of surgery
2013;258:248-56.
13. Desgranges P, Kobeiter H, Katsahian S, et al. Editor's Choice
- ECAR (Endovasculaire ou Chirurgie dans les Anevrysmes
aorto-iliaques Rompus): A French Randomized Controlled Trial
of Endovascular Versus Open Surgical Repair of Ruptured Aorto-
-iliac Aneurysms. European journal of vascular and endovascular
surgery : the official journal of the European Society for Vascular
Surgery 2015;50:303-10.
14. Powell JT, Sweeting MJ, Thompson MM, et al. Endovascular or
open repair strategy for ruptured abdominal aortic aneurysm:
30 day outcomes from IMPROVE randomised trial. BMJ (Clinical
research ed) 2014;348:f7661.
15. Endovascular strategy or open repair for ruptured abdominal
aortic aneurysm: one-year outcomes from the IMPROVE randomized
trial. European heart journal 2015;36:2061-9.
16. Powell JT, MD, IMPROVE Trial Investigators. Imperial College
London, London, United Kingdom. Three-Year Outcomes of the
IMPROVE Trial for Ruptured Abdominal Aortic Aneurysm. Journal
of vascular surgery 2017;June Supplement 2017.
17. Sterpetti AV, Cavallaro A, Cavallari N, et al. Factors influencing the
rupture of abdominal aortic aneurysms. Surgery, gynecology &
obstetrics 1991;173:175-8.
18. Brown LC, Powell JT. Risk factors for aneurysm rupture in patients
kept under ultrasound surveillance. UK Small Aneurysm Trial Participants.
Annals of surgery 1999;230:289-96; discussion 96-7.
19. Sweeting MJ, Thompson SG, Brown LC, Powell JT. Meta-analysis of
individual patient data to examine factors affecting growth and
rupture of small abdominal aortic aneurysms. The British journal
of surgery 2012;99:655-65.
20. Lederle FA, Johnson GR, Wilson SE. Abdominal aortic aneurysm in
women. Journal of vascular surgery 2001;34:122-6.
21. Baderkhan H, Goncalves FM, Oliveira NG, et al. Challenging
Anatomy Predicts Mortality and Complications After Endovascular
Treatment of Ruptured Abdominal Aortic Aneurysm. Journal
of endovascular therapy : an official journal of the International
Society of Endovascular Specialists 2016;23:919-27.
22. Noorani A, Page A, Walsh SR, Varty K, Hayes PD, Boyle JR. Mid-term
outcomes following emergency endovascular aortic aneurysm
repair for ruptured abdominal aortic aneurysms. European journal
of vascular and endovascular surgery : the official journal of
the European Society for Vascular Surgery 2012;43:382-5.
23. Quinn AA, Mehta M, Teymouri MJ, et al. The incidence and fate of
endoleaks vary between ruptured and elective endovascular
abdominal aortic aneurysm repair. Journal of vascular surgery 2017.
24. Broos PP, t Mannetje YW, Stokmans RA, et al. A 15-Year Single-
-Center Experience of Endovascular Repair for Elective and
Ruptured Abdominal Aortic Aneurysms. Journal of endovascular
therapy : an official journal of the International Society of Endovascular
Specialists 2016;23:566-73.
25. Roos H, Djerf H, Brisby Jeppsson L, et al. Re-interventions after endovascular
aortic repair for infrarenal abdominal aneurysms: a retrospective
cohort study. BMC cardiovascular disorders 2016;16:124.
26. van Beek SC, Vahl A, Wisselink W, Reekers JA, Legemate DA, Balm
R. Midterm Re-interventions and Survival After Endovascular
Versus Open Repair for Ruptured Abdominal Aortic Aneurysm.
European journal of vascular and endovascular surgery : the
official journal of the European Society for Vascular Surgery
2015;49:661-8.
27. Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D,
Sculpher MJ. Endovascular versus open repair of abdominal aortic
aneurysm. The New England journal of medicine 2010;362:1863-71.
28. De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open
or endovascular repair of abdominal aortic aneurysm. The New
England journal of medicine 2010;362:1881-9.
29. Lederle FA, Freischlag JA, Kyriakides TC, et al. Long-term comparison
of endovascular and open repair of abdominal aortic aneurysm.
The New England journal of medicine 2012;367:1988-97.
30. Becquemin JP, Pillet JC, Lescalie F, et al. A randomized controlled
trial of endovascular aneurysm repair versus open surgery for
abdominal aortic aneurysms in low- to moderate-risk patients.
Journal of vascular surgery 2011;53:1167-73 e1.
31. Lesperance K, Andersen C, Singh N, Starnes B, Martin MJ. Expanding
use of emergency endovascular repair for ruptured abdominal
aortic aneurysms: disparities in outcomes from a nationwide
perspective. Journal of vascular surgery 2008;47:1165-70;
discussion 70-1.
32. Moore R, Nutley M, Cina CS, Motamedi M, Faris P, Abuznadah W.
Improved survival after introduction of an emergency endovascular
therapy protocol for ruptured abdominal aortic aneurysms.
Journal of vascular surgery 2007;45:443-50.
33. Gupta PK, Ramanan B, Engelbert TL, Tefera G, Hoch JR, Kent KC. A
comparison of open surgery versus endovascular repair of unstable
ruptured abdominal aortic aneurysms. Journal of vascular
surgery 2014;60:1439-45.
34. Anain PM, Anain JM, Sr., Tiso M, Nader ND, Dosluoglu HH. Early
and mid-term results of ruptured abdominal aortic aneurysms in
the endovascular era in a community hospital. Journal of vascular
surgery 2007;46:898-905.
35. Starnes BW, Quiroga E, Hutter C, et al. Management of ruptured
abdominal aortic aneurysm in the endovascular era. Journal of
vascular surgery 2010;51:9-17; discussion -8.
36. Endovascular aneurysm repair versus open repair in patients with
abdominal aortic aneurysm (EVAR trial 1): randomised controlled
trial. Lancet (London, England) 2005;365:2179-86.
37. Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing
conventional and endovascular repair of abdominal aortic aneurysms.
The New England journal of medicine 2004;351:1607-18.
38. Lederle FA. Abdominal aortic aneurysm--open versus endovascular
repair. The New England journal of medicine 2004;351:1677-9.
39. Bastos Goncalves F, Baderkhan H, Verhagen HJ, et al. Early sac
shrinkage predicts a low risk of late complications after endovascular
aortic aneurysm repair. The British journal of surgery
2014;101:802-10.
40. t Mannetje YW, Cuypers PW, Saleem BR, Bode AS, Teijink JA, van
Sambeek MR. Comparison of midterm results for the Talent and
Endurant stent graft. Journal of vascular surgery 2017.
41. Singh MJ, Fairman R, Anain P, et al. Final results of the Endurant
Stent Graft System in the United States regulatory trial. Journal
of vascular surgery 2016;64:55-62.
42. Greenberg RK, Chuter TA, Cambria RP, Sternbergh WC, 3rd, Fearnot
NE. Zenith abdominal aortic aneurysm endovascular graft.
Journal of vascular surgery 2008;48:1-9.
Published
2018-12-02
Section
Review Article