Reintervention after abdominal aortic aneurysm repair – who is to blame?

Authors

  • Filipa Jácome Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal https://orcid.org/0000-0001-9582-0631
  • Beatriz Ribeiro Faculdade de Medicina da Universidade do Porto, University of Porto, Portugal https://orcid.org/0000-0001-5658-295X
  • Marina Dias Neto Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal https://orcid.org/0000-0002-7934-2016

DOI:

https://doi.org/10.48750/acv.451

Keywords:

Abdominal aortic aneurysm, surveillance, surgery, endovascular

Abstract

Introduction: Endovascular repair of abdominal aortic aneurysm (EVAR) is often recommended as first option for patients with suitable abdominal aortic aneurysm (AAA) anatomy. Nevertheless, this treatment carries higher reintervention rates and possibly higher aneurysm and all cause-related mortality in the long run versus open surgery. This narrative review aims to convey recent data about surveillance and the frequency and indications for reintervention after EVAR.

 

Methods: A comprehensive narrative review was conducted, providing a critical and objective analysis of the current knowledge on a topic.

 

Results:

EVAR-1 trial reported lower total and aneurysm-related mortality in the first 6 months after EVAR patients, with increasing follow-up time the mortality rate increased, leading to a higher total and aneurysm-related mortality, comparing with the open surgical repair group.

There is no consensus on EVAR surveillance, and in the 15-year follow-up of EVAR-1 trial they found that EVAR is associated with a reintervention rate of up to 20% in the first 4 years. There is a press in need for a homogeneity and contemporary appraisal of surveillance after EVAR and in indications for reintervention. In order to accomplish that, it is of paramount importance that centers undergoing EVAR programs publish their results about the compliance of follow up after EVAR and reintervention rates.

 

Conclusion:         

Long term outcomes are the Achilles heel of the endovascular AAA repair. Adequate follow up and reintervention are of paramount importance for EVAR to achieve its full potential.

 

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References

Wanhainen A, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. Editor’s Choice e European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57:8-93

EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005;365:2179-86.

Prinssen M, Verhoeven E, Buth J,Cuypers P, van Sambeek M, Balm R , et al. Randomized Trial Comparing Conventional and Endovascular Repair of Abdominal Aortic Aneurysms. N Engl J Med. 2004;351:1607-18.

Pitton MB, Jungmann F, Kloeckner R, Schotten S, Wirth G, Mittler J, et al. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade. Eur Radiol. 2015;25:2004-14.

Becquemin JP. The ACE trial: a randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm. J Vasc Surg. 2009;50:222-4.

Powell J, Ulug P, Blankensteijn JD, Lederle FA, Becquemin JP, Greenhalgh RM, et al. Meta-analysis of individual-patient data from EVAR- 1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg. 2017;104:166–78

Mazzei M, Mazzei FG, Squitieri NC, Notaro D, de Donato G, Galzerano G, et al. Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications. World J Radiol. 2016;28:530-6.

Patel SR, Allen C, Grima MJ, Brownrigg JRW, Patterson BO, Holt PJ, et al. A Systematic Review of Predictors of Reintervention After EVAR: Guidance for Risk-Stratified Surveillance. Vasc Endovascular Surg 2017;51:417-28.

Patel R, Powell JT, Greenhalgh RM, for the EVAR trial investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388:2366–74.

Baderkhan H, Haller O, Björck M, Mani K. Editor’s Choice – Detection of Late Complications After Endovascular Abdominal Aortic Aneurysm Repair and Implications for Follow up Based on Retrospective Assessment of a Two Centre Cohort. Eur J Vasc Endovasc Surg. 2020;60:171-9.

Li BB, Khan S, Salata K, Hussain MA, Mestra Cl, Greco E, et al. A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm. J Vasc Surg 2019;70:954-69.

Teijink J, Böckler D, Peeters P, Sterkenburg S, Bouwman L, Verhagen HJ, et al. Editor's Choice – Five Year Outcomes of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair in the ENGAGE Registry. Eur J Vasc Endovasc Surg. 2019;58:175-81.

Godfrey AD, Morbi AH, Nordon IM. Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair. Cardiovasc Intervent Radio. 2015;38:1130-6.

Karthikesalingam A, Page AA, Pettengell C, Hinchliffe RJ, Loftus IM, Thompson MM, et al. Heterogeneity in Surveillance after Endovascular Aneurysm Repair in the UK. Eur J Vasc Endovasc Surg. 2011;42:585-90.

Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67:2-77.

NICE. Abdominal aortic aneurysm: diagnosis and management. NICE guidelines. 2020. https://www.nice.org.uk/guidance/ng156

Cohen J, Pai A, Sullivan TM, Alden P, Alexander JQ, Cragg A, et al. A Dedicated Surveillance Program Improves Compliance with Endovascular Aortic Aneurysm Repair Follow-up. Ann Vasc Surg. 2017;44:59-66.

Garg T, Baker LC, Mell MW. Adherence to postoperative surveillance guidelines after endovascular aortic aneurysm repair among Medicare beneficiaries. J Vasc Surg. 2015;61:21-7

de Mik SML, Geraedts ACM, Ubbink DT, Balm R. Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis. J Endovasc Ther. 2019;26:531–41.

Grima MJ, Boufi M, Law M, Jackson D, Stenson K, Patterson B, et al. Editor’s Choice – The Implications of Non-compliance to Endovascular Aneurysm Repair Surveillance: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg. 2018;55:492–502

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Published

2022-09-11

How to Cite

1.
Jácome F, Ribeiro B, Dias Neto M. Reintervention after abdominal aortic aneurysm repair – who is to blame?. Angiol Cir Vasc [Internet]. 2022 Sep. 11 [cited 2024 Mar. 28];18(2):82-5. Available from: https://acvjournal.com/index.php/acv/article/view/451

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Section

Review Article