Endovascular Repair Of Delayed Endologix AFX Graft Failure Is Superior To Open Repair With Explant

Abstract

<h3>INTRODUCTION AND OBJECTIVES</h3> Prior studies have described delayed failure of the Endologix Endovascular AAA System (AFX) with resultant aneurysm sac pressurization and increased risk of rupture. While there is no consensus on operative strategy to deal with this endograft failure, options include re-lining with a contemporary endograft or open graft explant. The purpose of this study is to compare these two surgical treatment options in our own single institution experience. <h3>METHODS</h3> A retrospective review was performed of 122 AFX endografts implanted at our tertiary care center from 2013-2019. Thirty-seven patients were found to have delayed endograft failure and subsequently underwent re-line(n=25) or explant(n=12). All re-interventions were performed for endoleak identified on imaging, sac expansion, and/or rupture. Primary composite outcome was successful aneurysm exclusion without mortality at 30-days. Secondary endpoints included hospital length of stay and operative time. Patients without appropriate follow-up were excluded unless death occurred within the perioperative period. <h3>RESULTS</h3> Thirty-seven patients were identified, of which 25 underwent re-line and 12 explant. There were no differences in age, gender, race comparatively(p>0.05), or reason for re-intervention (presence of endoleak, endoleak type, rupture)(p>0.05) There was no significant difference in the primary composite endpoint of successful aneurysm exclusion without death within 30-days between graft re-line(76.0%) and explant(75.0%) (p=0.95). Graft re-line had a significantly shorter hospital length of stay (2.20±2.25d vs. 8.64±7.38d (p<0.01)) and operative time (164.1±110.4min vs. 272.6±113.7min (p=0.01)). Additionally, operative time for the re-line cohort was not significantly different than that of their original EVAR(p=0.29). There were 3(25%) deaths in the explant cohort compared to zero in the re-line cohort although 2(8%) went on to require explant. <h3>CONCLUSIONS</h3> Endograft re-line, although off IFU, does produce analogous aneurysm exclusion rates when compared to explant in Endologix AFX failures, with a reduction in OR time, hospital length of stay and mortality.