New England Society for Vascular Surgery

Outcomes Of Secondary Interventions Following Endovascular Repair In Patients With Challenging Aortoiliac Anatomy: A Prospective Analysis

Manish Mehta, Yaron Sternbach, R Clement Darling, III, Sean P. Roddy, Philip S.K. Paty, Kathleen J. Ozsvath, Paul B. Kreienberg, Benjamin B. Chang, Dhiraj M Shah
Albany Medical College, Albany, NY

Introduction and Objectives:
To evaluate the outcomes of secondary interventions in patients with challenging aortoiliac morphology undergoing endovascular aneurysm repair (EVAR).
Methods:
From 2002-2005, 635 patients underwent EVAR with a variety of commercially available stentgrafts (AneuRx, Excluder, Zenith), and 232 (37%) of these patients had challenging aortoiliac anatomy that would have precluded them from pivotal stentgraft trials. Data was prospectively collected on all procedures and patients underwent routine follow-up with CT scan every 6 months. Patients with significant stentgraft migration, limb stenoses, occlusion, endoleaks, iliac aneurysm formation, and aneurysm rupture underwent secondary interventions.
Results:
Over a mean follow-up of 20 months, 48 (21%) of 232 patients with challenging aortoiliac anatomy required 57 secondary procedures for stentgraft migration (n=28, 49%), type I endoleak (n=2, 4%), type II endoleak (n=14, 25%), type III endoleak (n=1, 2%), limb thrombosis (n=5, 9%), iliac aneurysm formation (n=4, 7%), and aneurysm rupture (n=3, 5%). Six (3%) patients required more than one additional procedure. Two (0.9%) patients underwent successful elective conversion to open surgical repair for stentgraft migration from proximal infrarenal aortic neck. All 3 patients with aneurysm rupture following EVAR were successfully treated by endovascular means (n=2) or open surgical repair (n=1). One patient died after the initial EVAR, and none of the patients with secondary procedures suffered from myocardial infraction, ischemic colitis, limb loss, or death.
Conclusions:
Although a significant number of patients with challenging aortoiliac morphology might require secondary procedures, a vast majority of these can be managed by endovascular means with a limited morbidity and mortality.