Evar with the Use of New Generation Endografts is a Safe and Durable Procedure

Abstract

Introduction: Endovascular aneurysm repair (EVAR) has become the treatment of choice for abdominal aortic aneurysm (AAA) demonstrating low peri-operative mortality and morbidity rates and excellent early outcomes. However, its durability in the long-term has been questioned. The aim of this study was to assess the long-term outcomes of EVAR with the use of new generation endografts. Methods: Between 2007-2018, 587 patients were treated with standard elective EVAR in a single tertiary center. In the analysis only cases with at least 2 years of follow up were included. The impact of anatomical AAA characteristics, cardiovascular risk factors, comorbidities and intra-operative details were assessed in the long-term outcomes such as mortality, limb occlusion, re-intervention rates, endoleak type I (ETI) and II (ETII), sac remodeling, major cardiovascular events (MACE) and cancer. Results: 215 patients with a mean age of 72±7.3 (m: 94%) and mean AAA diameter of 59±11mm were included in the study. The mean follow up was 5±3 years (median 4 years). The survival rate was 96.6% (SE 1.3%), 83.3% (SE 3%) and 51% (SE 6.6%), at 3, 6 and 10 years of follow up, respectively. In total 43 patients died during 10 years of follow up (41 from MACE of which 12 had also a diagnosis of cancer and 2 from cancer). Mortality was not associated with age, AAA anatomy characteristics, co-morbidities, intra-operative details, presence of ET I or II and sac remodelling. After multivariate regression analysis, the initial duration of in-hospital stay (1.11, CI. 1.04-1.19; p=0.001) was the only factor associated with the survival. The freedom from limb occlusion rate was 98% (SE 1%) and 97.5% (SE 1.1%) at 2 y and 4 years respectively; 4 out of 5 events occurred at the first 2 years, and remaining at the 4th year. Freedom from re-intervention rate was 95% (SE 1.4%), 94% (SE 2%), 84% (SE 4%) and 75% (SE 6%) at 2, 4, 6, and 8 years of follow up. Freedom from ET II was 78%, 74% and 68% at 1, 5 and 9 years of follow up. Conclusion: Almost half of the patients will survive 10 years after EVAR and the cause of death is non-EVAR related resulting from cardiovascular events and cancer. Freedom from re-intervention and limb occlusion is highly acceptable. Limb occlusion was more common during first two post-operative years. Disclosure: Nothing to disclose