92 - Postersitzung
17. Mai 2019, 12:30 - 14:00, Bellavista 2, 6. OG
Re-interventions after endovascular aortic aneurysm repair in a community-based hospital: A retrospective cohort study
E. Psathas, P. Deslarzes, C. Landa, E. Monnard, M. Menth, B. Egger, D. O. Mayer, Presenter: E. Psathas (Fribourg)
Despite the evolution of aortic stent-grafts and endovascular techniques over the past decades, re-interventions and late complications remain the Achilles heel of endovascular aortic repair (EVAR). Our aim is to provide insight on these re-interventions, based on our experience after standard EVAR.
We retrospectively analyzed the medical records and follow-up data of all patients treated with EVAR in our community-based hospital, focusing on re-interventions, 30-day mortality and late survival. Ruptured and juxta-renal aneurysms were excluded. Re-interventions were classified as access-related or non-access-related. Standard descriptive statistics were calculated for pooled data, long-term survival and freedom from re-intervention determined by life-table analysis and Kaplan-Meier curves (SPSS Statistics Software version 23.0).
Median follow-up of a total of 58 patients treated with standard EVAR from January 2011 to December 2018 was 29 (range 1-92) months. Thirteen patients (22.4%) underwent 17 re-interventions. Access-related re-interventions included two femoral patch angioplasties for postoperative thrombosis, one groin re-exploration for an infected lymphocele and one removal of an infected femoro-femoral graft followed by ilio-femoral crossover vein bypass with a mean time to re-intervention of 3 (range 1-8) days. Indications for non-access-related re-interventions were sac enlargement with endoleak or limb occlusion. Procedures included embolization (n=5), additional iliac stent graft (n=4), proximal extension (n=2), one endograft removal and one femoral crossover bypass (Table 1). Mean time to re-intervention for non-access related re-interventions was 23.2 months (range 10 days - 81 months). Thirty-day mortality was 5.9% (1/17) after all re-interventions compared to 5% (3/58) after primary EVAR. There was no significant difference in 5-years survival in patients with and without re-interventions (Fig. 1)
Re-interventions after EVAR are common and may be challenging, however, long-term survival is not influenced by them. While access-related complications usually have to be addressed by open surgical procedures, most of the non-access related problems occur late during follow-up and can be treated endovascularly. All these facts emphasize the need for long-term surveillance of all patients undergoing EVAR.