Re-interventions After Endovascular Repair for Infrarenal Abdominal Aortic Aneurysms

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Introduction: Morbidity and mortality after endovascular abdominal aortic aneurysm repair (EVAR) is significantly lower than open repair. Reintervention rates and late complications after EVAR however have been reported to be higher compared to open repair in the international literature. The aim of this study was to identify and document all re-interventions after EVAR performed for intact abdominal aortic aneurysm at a single center since the introduction of EVAR in this center in 2009 Methods: This is a retrospective single-centre cohort study of re-interventions after standard EVAR. Consecutive patients (n=113) who were treated for non ruptured infrarenal aneurysms between 2009 and 2018 were included in this study. All patients undergoing EVAR were routinely followed up with a duplex scan and a CT angiogram six weeks post EVAR, which were then repeated yearly if the initial results were satisfactory. Results: In total, 22 re-interventions were performed in 19 patients during follow-up. None of the interventions were access related. In all cases, the femoral arteries were exposed via open cutdown. The most common indications for reintervention were thrombosis or stenosis of a graft limb (n=18), type I endoleak (n=3) and type II endoleak (n=1). The most frequent procedures were femoro-femoral crossover graft (n=10), thrombectomy +/- angioplasty of the EVAR graft body or limb (n=5), stenting (n=2) or extension of graft limb (n=2), proximal extension (n=1), embolisation of type II endoleak (n=1). Endovascular technique was used in 27.3% of the re-interventions Conclusion: None of our re-interventions were done for access related complications but non-access-related intervention rates are still considerable after EVAR. In our centre, the commonest indication for intervention was graft limb thrombosis or stenosis. The commonest procedure was femoro-femoral crossover graft, followed by thrombectomy +/- angioplasty of the EVAR graft limb. Re-intervention rates are identical to reintervention rates reported in the literature. No aneurysm ruptures were recorded. Disclosure: Nothing to disclose