Long-term results of balloon-expandable LifePath endografts in abdominal aortic aneurysm: A single-center experience

Abstract

This retrospective single-center study analyzed long-term results after LifePath (Edwards Lifesciences LLC, Irvine, Calif) endoprosthesis implantation for abdominal aortic aneurysm (AAA), primarily focusing on the wire form fracture issue and consecutive endoleak rate. Between 1999 and 2004, all consecutive patients with LifePath AAA devices in our institution were included in the retrospective analysis. All patients had computed tomography angiography (CTA) imaging preoperatively and image postprocessing. The follow-up using CTA imaging specifically addressed material fatigue (wire form fractures) resulting in migrations and type I endoleaks. During the 6-year study period, which included the 1-year withdrawal and redesign of the device, 51 patients were treated with LifePath AAA endografts. The 30-day mortality was 0%. The perioperative 30-day morbidity was 9.8%. One patient required a primary conversion due to misdeployment of the iliac limbs within the graft main body. The primary endoleak rate was 20.56% (type I, 2%; type II, 19.6%). During the mean follow-up of 40.7 months, 12 patients died, six were lost to follow-up, and 32 underwent subsequent CTA imaging. Eight patients (25%) demonstrated a proximal type I endoleak, seven (22%) had a type II endoleak, and three had a type III endoleak (9%). In nine patients (28.1%), wire form fractures could be detected at image postprocessing. Four patients required a secondary conversion due to endoleak and aneurysm growth (2 type I endoleaks and 2 type III endoleaks). Wire form fracture is the major structural problem in the LifePath balloon-expandable endograft device, resulting in a significant endoleak rate. We must caution those patients with a LifePath device in-situ that careful follow-up must be performed due to material fatigue and they should consider secondary conversion.