Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report

Objective: The purpose of this study was to evaluate the need for secondary interventions after endovascular abdominal aortic aneurysm repair with current stent-grafts. Methods: Studied were data from 2846 patients treated from December 1999 until December 2004. The data were recorded from the EUROSTAR registry. The only patients studied were those with a follow-up of at least 12 months or until they had a secondary intervention within the first 12 months. The cumulative incidences of secondary transabdominal, extra-anatontic, and transfemoral interventions during follow-up (after the first postoperative month) were investigated. Results: A secondary intervention was performed in 247 patients (8.7%) at a mean of 12 months after the initial procedure within a follow-Lip period of a mean of 23 12 months. Of these, 57 (23%) transabdominal, 43 (16%) involved an extra-anatomic bypass, and 147 (60%) were by transfemoral approach. The cumulative incidence of secondary interventions was 6.0%, 8.7%, 12%, and 14% at 1, 2, 3, and 4 years, respectively. This corresponded with an annual rate of secondary interventions of 4.6%, which was remarkably lower than in a previously published EUROSTAR study of patients treated before 1999. Type I endoleaks (33% of procedures), migration (16%), and rupture (8.8%) were the most frequent reasons for secondary transabdominal interventions. Graft limb thrombosis was the indication for extra-anatomic bypass (60%). Type I endoleak (17%), type II endoleak (23%), device limb stenosis (14%), thrombosis (23%), and device migration (14%) were the most frequent reasons for secondary transfemoral interventions. Operative mortality was higher after secondary transabdominal interventions (12.3%, P =.007) compared with transfemoral interventions (2.7%). Overall survival was lower in patients with secondary transabdominal (P =.016) and extra-anatomic interventions (P <.0001) compared with patients without a secondary intervention. Conclusion: Although the incidence of secondary interventions after endovascular aneurysm repair has substantially decreased in recent years, continuing need for surveillance for device-related complications remains necessary.