1. Analysis of Outcomes After Endovascular Abdominal Aortic Aneurysm Repair in Patients With Abnormal Findings on the First Postoperative Computed Tomography Angiography
- Author
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Anna C. M. Geraedts, Sana Mulay, Susan van Dieren, Mark J. W. Koelemay, Ron Balm, R. Balm, J. W. Elshof, B. H. P. Elsman, J. F. Hamming, M. J. W. Koelemay, R. H. J. Kropman, P. P. Poyck, G. W. H. Schurink, A. A. E. A de Smet, S. M. van Sterkenburg, C. Ünlü, A. C. Vahl, H. J. M. Verhagen, P. W. H. E. Vriens, J. P. P. M. de Vries, J. J. Wever, W. Wisselink, C. J. Zeebregts, Graduate School, Surgery, ACS - Atherosclerosis & ischemic syndromes, APH - Methodology, Amsterdam Gastroenterology Endocrinology Metabolism, Robotics and image-guided minimally-invasive surgery (ROBOTICS), Cell biology, Erasmus School of Law, Neurology, and Child and Adolescent Psychiatry / Psychology
- Subjects
medicine.medical_specialty ,Endoleak ,Computed Tomography Angiography ,medicine.medical_treatment ,Clinical Investigations ,030204 cardiovascular system & hematology ,030230 surgery ,Endovascular aneurysm repair ,endovascular aneurysm repair ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,abdominal aortic aneurysm ,Risk Factors ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,postoperative complication ,Computed tomography angiography ,Retrospective Studies ,reintervention ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Postoperative complication ,medicine.disease ,Abdominal aortic aneurysm ,Treatment Outcome ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal - Abstract
Purpose: Lifelong follow-up after endovascular abdominal aortic aneurysm repair (EVAR) is recommended due to a continued risk of complications, especially if the first postoperative imaging shows abnormal findings. We studied the long-term outcomes in patients with abnormalities on the first postoperative computed tomography angiography (CTA) following EVAR. Materials and Methods: This is a retrospective study of all consecutive patients who underwent elective EVAR for nonruptured abdominal aortic aneurysm (AAA) between January 2007 and January 2012 in 16 Dutch hospitals with follow-up until December 2018. Patients were included if the first postoperative CTA showed one of the following abnormal findings: endoleak type I–IV, endograft kinking, infection, or limb occlusion. AAA diameter, complications, and secondary interventions during follow-up were registered. Primary endpoint was overall survival, and other endpoints were secondary interventions and intervention-free survival. Kaplan-Meier analyses were used to estimate overall and intervention-free survival. Cox regression analyses were used to identify the association of independent determinants with survival and secondary interventions. Results: A total of 502 patients had abnormal findings on the first postoperative CTA after EVAR and had a median follow-up (interquartile range IQR) of 83.0 months (59.0). The estimated overall survival rate at 1, 5, and 10 years was 84.7%, 51.0%, and 30.8%, respectively. Age [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.05 to 1.10] and American Society of Anesthesiologists (ASA) classification (ASA IV HR 3.20, 95% CI 1.99 to 5.15) were significantly associated with all-cause mortality. Overall, 167 of the 502 patients (33.3%) underwent 238 secondary interventions in total. Fifty-eight patients (12%) underwent an intervention based on a finding on the first postoperative CTA. Overall survival was 38.4% for patients with secondary interventions and 44.5% for patients without (log rank; p=0.166). The intervention-free survival rate at 1, 5, and 10 years was 82.9%, 61.3%, and 45.6%, respectively. Conclusions: Patients with abnormalities on the first postoperative CTA after elective EVAR for infrarenal AAA cannot be discharged from regular imaging follow-up due to a high risk of secondary interventions. Patients who had a secondary intervention had similar overall survival as those without secondary interventions.
- Published
- 2021