Back to Search
Start Over
A Canadian multicenter experience describing outcomes after endovascular abdominal aortic aneurysm repair stent graft explantation.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2021 Sep; Vol. 74 (3), pp. 720-728.e1. Date of Electronic Publication: 2021 Feb 16. - Publication Year :
- 2021
-
Abstract
- Background: Most studies describing the outcomes after endovascular abdominal aortic aneurysm repair (EVAR) explantation have been from single, high-volume, centers. We performed a multicenter cross-Canadian study of outcomes after EVAR stent graft explantation. Our objectives were to describe the outcomes after late open conversion and EVAR graft explantation at various Canadian centers and the techniques and outcomes stratified by the indication for explant.<br />Methods: The Canadian Vascular Surgery Research Group performed a retrospective multicenter study of all cases of EVAR graft explantation at participating centers from 2003 to 2018. Data were collected using a standardized, secure, online platform (RedCap [Research Electronic Data Capture]). Univariate statistical analysis was used to compare the techniques and outcomes stratified the indication for graft explantation.<br />Results: Patient data from 111 EVAR explants collected from 13 participating centers were analyzed. The mean age at explantation was 74 years, the average aneurysm size was 7.5 cm, and 28% had had at least one instructions for use violation at EVAR. The average time between EVAR and explantation was 42.5 months. The most common indication for explantation was endoleak (n = 66; type Ia, 46; type Ib, 2; type II, 9; type III, 2; type V, 7), followed by infection in 20 patients; rupture in 18 patients (due to type Ia endoleak in 10 patients, type Ib in 1, type II in 1, type III in 2, and type V in 1), and graft thrombosis in 7 patients. The overall 30-day mortality was 11%, and 45% of the patients had experienced at least one major perioperative complication. Mortality was significantly greater for patients with rupture (33.3%) and those with infection (15%) compared with patients undergoing elective explantation for endoleak (4.5%; P = .003). The average center volume during the previous 15 years was 8 cases with a wide range (2-19 cases). A trend was seen toward greater mortality for patients treated at centers with fewer than eight cases compared with those with eight or more cases (19% vs 9%). However, the difference did not reach statistical significance (P = .23). Overall, 41% of patients had undergone at least one attempt at endovascular salvage before explantation, with the highest proportion among patients who had undergone EVAR explantation for endoleak (51%). Only 22% of patients with rupture had undergone an attempt at endovascular salvage before explantation.<br />Conclusions: The performance of EVAR graft explantation has increasing in Canada. Patients who had undergone elective explantation for endoleak had lower mortality than those treated for either infection or rupture. Thus, patients with an indication for explanation should be offered surgery before symptoms or rupture has occurred. A trend was seen toward greater mortality for patients treated at centers with lower volumes.<br /> (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal diagnostic imaging
Aortic Aneurysm, Abdominal mortality
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation mortality
Canada
Endoleak diagnostic imaging
Endoleak etiology
Endoleak mortality
Endovascular Procedures adverse effects
Endovascular Procedures mortality
Female
Graft Occlusion, Vascular diagnostic imaging
Graft Occlusion, Vascular etiology
Graft Occlusion, Vascular mortality
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Male
Middle Aged
Prosthesis-Related Infections diagnosis
Prosthesis-Related Infections etiology
Prosthesis-Related Infections mortality
Retrospective Studies
Risk Assessment
Risk Factors
Thrombosis diagnostic imaging
Thrombosis etiology
Thrombosis mortality
Time Factors
Treatment Outcome
Aortic Aneurysm, Abdominal surgery
Blood Vessel Prosthesis adverse effects
Blood Vessel Prosthesis Implantation instrumentation
Device Removal adverse effects
Device Removal mortality
Endoleak surgery
Endovascular Procedures instrumentation
Graft Occlusion, Vascular surgery
Prosthesis-Related Infections surgery
Stents adverse effects
Thrombosis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 74
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 33600929
- Full Text :
- https://doi.org/10.1016/j.jvs.2021.01.049