“Large Diameter” Aortic Endografts Are Associated With Aneurysm Sac Expansion

Abstract

<h3>INTRODUCTION AND OBJECTIVES</h3> This study's purpose was to evaluate the association between aortic endograft diameter and long-term outcomes following endovascular aneurysm repair (EVAR) performed in accordance with manufacturer instructions for use (IFU). <h3>METHODS</h3> Retrospective review of consecutive patients undergoing on-IFU EVAR (2000-2018) was performed to compare long-term patient outcomes based on device diameter. "Large diameter" devices were defined as >34mm. The primary outcome was freedom from sac expansion throughout long-term follow-up. Analyses included bivariate analyses, Kaplan Meier with log-rank comparison, and multivariate Cox regression.Figure 1Figure 1 <h3>RESULTS</h3> A total of 1099 patients underwent on-IFU EVAR from 2000-2018. Follow-up data were available for 980 patients. Of these, 75 (7.6%) were treated with >34 mm devices. There were no significant differences in demographics or co-morbidities between the two groups, although pre-operative AAA size was greater in the large diameter group (58 ± 8.5 mm vs. 56 ± 17.4 mm; p=0.05). Median follow-up was 10.3 years. Patients with grafts >34 mm had decreased freedom from sac expansion (p=0.038) (Figure 1). Multivariate Cox regression identified independent factors associated with sac expansion, including age, pre-operative AAA size, reinterventions, and >34 mm endografts (Table 1). <h3>CONCLUSION</h3> Large diameter aortic endografts are associated with higher rates of sac expansion during long-term follow-up. While there is a role for large diameter grafts in select patients, it is important to recognize that these devices were often approved <i>post-hoc</i> without the same regulatory scrutiny of smaller endografts. These findings underscore the importance of surveillance for patients treated with >34 mm grafts.