Outcomes Analysis of Endovascular Repair for Giant Abdominal Aortic Aneurysms

Abstract

Introduction: Aortic aneurysm diameter has been reported to be a predictor of poor outcomes in the long-term follow-up: in particular, previous analysis showed that the risk of complications is increased and outcomes following repair are worse when diameter exceeds 80 mm. Since the more the aorta enlarges the more the anatomy increases in complexity, open surgical repair has been the method of treatment of almost all larger aneurysms reported in Literature so far. The aim of this paper is to report the results of endovascular repair (EVAR) of “giant” abdominal aortic aneurysms (g-AAAs). Methods: This is a multicenter, observational cohort registry-based study with retrospective analysis of all AAAs extrapolated from the 5014 patients enrolled in the Global Registry for Endovascular Aortic Treatment (GREAT). Main outcomes were primary technical success, freedom from aortic-related mortality (ARM), and freedom from device-related reinterventions. Results: One-hundred twenty-eight (2.5%) cases were treated. There were 115 (89.8%) males. All AAAs involved the infrarenal aorta; in 14 (11%) cases the aneurysmal disease involved one common iliac artery at least. Overall, mean age was 74 ± 8 (range, 50-92) and the mean AAA diameter was 91 mm ± 10 (range, 81-150). Primary technical success was achieved in all cases. In-hospital and EVAR-related mortality was never observed. At a mean follow-up of 444 days, neither rupture nor aorto-enteric fistulization was observed. Ten (7.8%) patients required aortic-related reintervention and conversion to open repair occurred in 1 (0.8%) only. An endoleak was detected in 9 (7%) cases (type 2, n = 6; type 1a (n = 3). At 12 months window, aneurysm sac stabilization or shrinkage was observed in 92% of the cases. Conclusion: Preliminary “real-world” experience of EVAR for g-AAAs shows that g-AAA is a rare event, and that EVAR has satisfactory outcomes at short-term follow-up. Although concerns remain for long-term durability, EVAR-related complications rate was acceptably low with no additional aortic-related mortality. Longer follow-up data are expected to confirm durability of these results. Disclosure: Nothing to disclose