Preliminary Results of the Evar 30-D SACVA Registry. The First and Largest Multicentric Registry in Southern Spain of Evar for Abdominal Aortic Aneurysms

Abstract

Introduction: EVAR has been adopted worldwide as a standard approach for AAA in high risk patients unfit for open repair (OR), but also offered to no high-risk patients with no friendly anatomy for EVAR, based in the lower short-term morbidity of the endovascular approach. But published data are still controversial about the benefits of this approach in patients fit for surgery or with hostile aortic anatomies. Methods: Consecutive cases included from January 2016 to December 2017 in a collaboration between 10 Vascular Surgery departments and the Sociedad Andaluza de Angiología y C Vascular(SACVA). Retrospective multicentre data collected through specific designed formularies analyzed by the statistical department FIBAO(CHU Jaen). Initial descriptive analysis are presented in this paper. Results: 372 cases were collected from 10 centers, range cases/center (74-3). Elective EVAR 306(82%) and emergent EVAR 66 cases(18%). Epidemiological data: 357(96%) males and 15(4%) females, mean age of 73,69y.o. for no emergent EVAR VS 75y.o. for emergent EVAR. Tobacco use(89%) followed by arterial hypertension(80%) are the most prevalent cardiovascular risk factors. Based on AAA anatomy 76% were aortic aneurysms, 21% aorto-iliac and just 3% isolated iliac aneurysms. Mean of the AAA max diameter was 60.44mm for elective VS 75.54mm for emergent/ruptured cases. Mean neck diameter at renal arteries level was 24,3mm for elective VS 24.9mm for emergencies, and 2cm lower to renal was 26.57mm for elective vs 27.99mm for emergent. Anaesthetic risk 57.4% of the patients were ASA III and 25.7% ASA IV. Percutaneous access in 41.8% of the elective and 27.3% of the emergent cases. 29.7% of the cases where considered hostile neck anatomies, with 18.8% treated out of the instructions of use(IFU's) of the stentgraft. Stentgraft devices: 45.9 % with infrarenal fixation versus 54.1% suprarenal fixation. Technical success for EVAR achieved in 97.8%, with a conversion to OpenRepair rate inferior to 1.3%. 30-D endoleaks in 17.5% of the cases, from those 6% classed as type I. Hospital stay for elective EVAR was 4.85 days VS 8.44 for emergencies. Post-Implant syndrome in 17.4% patients. 30-D mortality for the 62 emergent cases was 22.2% VS 0.7% for the 312 elective. No major 30-D complications reported after EVAR in 85% of the elective cases versus 57.1% of the emergencies. Conclusion: The results of this multicentric registry, the largest with these characteristics performed in Spain shows similar 30-D results compared with other international registries and trials published in the literature, with a global decrease in 30-D mortality, lower than 1.5% for elective AAA repair and close to 20% for ruptured AAA, and reported technical success of superior to 98%. But the elevate number of cases included in this registry performed in hostile necks and out of the stentgrafts IFU's should be clearly remarked. Although it seems not to be relevant at the initial presented 30-D data after EVAR there is a need of close follow-up of these patients and it is mandatory to report the mid and long-term results of these patients over the next years. Disclosure: Nothing to disclose