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Lessons learned from the long-term follow-up of a first-generation aortic stent graft.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2003 Feb; Vol. 37 (2), pp. 367-73. - Publication Year :
- 2003
-
Abstract
- Objective: Endovascular repair (EVR) of abdominal aortic aneurysm (AAA) is being performed with increasing frequency worldwide. No studies have a complete follow-up of more than 4 years. Our study objective was to assess the long-term results and the durability of a first-generation stent graft with complete 7-year follow-up.<br />Methods: Between March 1994 and May 1995, 23 consecutive patients underwent treatment with the Chuter stent graft at a single center. All patients underwent computed tomographic scan before discharge, at 3 and 6 months, and annually thereafter. The data were prospectively collected on all patients. The median follow-up period was 72.5 months (range, 0.2 to 91 months). None of the patients were lost to follow-up.<br />Results: Among these 21 men and two women with a median age of 69 years (range, 52 to 85 years), 11 (47.8%) were at high risk. The 30-day technical success rate was 87%. Acute (30-day) complications were one graft deployment failure (4.3%) that necessitated an immediate conversion, 20 intraoperative graft limb kinks (87%), all of which needed additional Wallstent (Schneider, Minneapolis, Minn) placement, four renal failures (17.4%), one type Ia endoleak complicated with AAA rupture (4.3%), and three perioperative deaths (13%). Late complications were eight type I or II endoleaks (34.8%) after a mean delay of 23.9 months (range, 3 to 69 months), 13 proximal stent migrations (56.5%) after a mean delay of 29.6 months (range, 7 to 58 months), six graft limb thromboses (26.1%) after a mean delay of 38.7 months (range, 3 to 71 months), one AAA rupture (4.3%), and 11 deaths (47.8%), with five AAA-related deaths (21.7%). The 3-year, 5-year, and 7-year cumulative endoleak rates were 34%, 41%, and 49%, respectively; the cumulative migration rates were 66%, 75%, and 75%, respectively; and the cumulative open surgery rates were 30%, 50%, and 50%, respectively. At the same intervals, the cumulative survival rates for any death were 69%, 56%, and 49%, respectively; the cumulative survival rates for AAA-related deaths were 82%, 82%, and 73%, respectively; and the cumulative secondary success rates were 54%, 28%, and 28%, respectively.<br />Conclusion: This studies emphasizes the need for close lifelong surveillance of AAAs treated with EVR. Despite the small population of this series, a long-term follow-up highlights that the first-generation homemade stent graft evaluated in this study failed to adequately protect the patient from AAA-related death and that most of the serious complications were related to a late failure of the aortic neck attachment. Better proximal fixation of the aortic stent graft is essential to improve the durability of EVR.
- Subjects :
- Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Male
Middle Aged
Outcome Assessment, Health Care
Prospective Studies
Prosthesis Failure
Survival Rate
Time Factors
Aortic Aneurysm, Abdominal mortality
Aortic Aneurysm, Abdominal surgery
Blood Vessel Prosthesis Implantation adverse effects
Postoperative Complications
Stents adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 0741-5214
- Volume :
- 37
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 12563208
- Full Text :
- https://doi.org/10.1067/mva.2003.75