Secondary procedures after endovascular aortic aneurysm repair

Purpose: The purpose of this study was to evaluate the incidence, distribution, and indications of secondary procedures after endovascular aortic aneurysm repair (EAR). Methods. At a single institution, 179 patients underwent EAR with four different endografts (AneuRx, n = 117; Zenith, n = 49; Ancure, n = 12; and Talent, n = 1). The vascular section database was queried for patients who needed secondary procedures after the original EAR, The mean time from EAR to the termination of the study was 27.0 +/- 16.7 months. Type I or III endoleaks were treated aggressively. Type 11 endoleaks were treated only in the presence of aneurysm expansion. Results. Thirty-five (35/179; 19.6%) secondary procedures were performed in 32 patients. Indications for secondary procedures included 14 limb occlusions or stenoses (40.0%), 13 endoleaks (37.1%), six endograft migrations (17.1%), one delayed aneurysm rupture (2.8%), and one device malfunction (2.8%). Seven of the 10 early (<90 days) limb failures (70%) occurred within the first 60 patients. At that time, a protocol with aggressive external iliac artery evaluation was adopted. In the next 125 patients, the rate of early limb occlusion or stenosis was 2.4% (P =.025, with Fisher exact test). Distribution of secondary procedures included 23 endoluminal interventions (65.7%; angioplasty +/- stent placement, thrombolysis, endocuff placement, embolization), eight traditional peripheral procedures (22.9%; femoral-femoral bypass, thrombectomy), two laparoscopic interventions (5.7%; inferior mesenteric artery ligation), and two laparotomies (5.7%; delayed conversions). Interventions for limb occlusion or stenosis occurred earliest (3.5 +/- 5.4 months; P <.05, with analysis of variance), followed by treatment of endoleaks (14.3 +/- 12.9 months) and migration (27.5 +/- 10.4 months). The one delayed rupture occurred at 15.3 months. Conclusion: Secondary procedures after EAR are common. Reinterventions can be grouped temporally on the basis of indication. Treatment for limb ischemia is predominately early (greater than or equal to3 months), whereas treatment for endoleaks occurs at approximately 1 year and interventions for migration predominate after 2 years.