Endoleak Outcomes of Suprarenal vs. Infrarenal Endovascular Aneurysm Repairs Outside Instructions for Use Standards

Abstract

Purpose To determine if there are any differences in outcomes between infrarenal fixation (IF) and suprarenal fixation (SF) for the endovascular treatment of abdominal aortic aneurysms (AAAs) with aortic neck lengths ( Material and Methods A retrospective review of 561 endovascular aneurysm repairs (EVAR) procedures performed from 2004 to 2011 at a single institution. The charts and radiographic images of all patients were reviewed. Patients who underwent EVAR with AAA with short proximal neck lengths were stratified into 2 groups of IF (Gore Excluder) and SF (Cook Zenith). The primary end point of the study was the presence of endoleaks. The secondary end points were graft migration, postoperative rupture, and death. Results A total of 561 EVARs were performed during this study period with 52 identified as having a short proximal aortic neck. Seventeen patients were in the IF group and 34 in the SF group. The mean follow up period was 33.9 months for the IF group and 23.4 months for the SF group. There was no difference in the average proximal neck length (8.8 mm IF vs. 9.9 mm SF; p = not significant [NS]) or the preoperative AAA size (23.7 mm IF vs. 25.2 mm SF; p = NS). There were no significant differences in age (74.7 years IF vs. 78.2 years SF; p = NS), gender (IF 94% male vs. SF 88% male; p = NS) or length of stay (2.2 days IF vs. 3 days SF; p = NS). There was one type II endoleak in both the IF and SF groups at 90-day follow up. At 1 year, the type II endoleak in the IF group persisted while the 1 patient with a type II endoleak in the SF group died. There were no migrations noted in either group. There were no ruptures in the IF group and 1 rupture in the SF group (p = NS). There were 5 deaths in the IF group and 5 deaths in the SF group (p = NS). Conclusions There was no significant difference in endoleak rates between SF and IF for patients with short aortic neck lengths outside IFU standards.