Ten-year Results of Endovascular Abdominal Aortic Aneurysm Repair (EVAR) from a Large Multicenter Registry

Abstract

This study assessed long-term outcomes after endovascular aneurysm repair (EVAR) in an integrated health care system. Between 2000 and 2010, 1736 patients (86% were men) underwent EVAR at 17 centers. Demographic data, comorbidities, and outcomes of interest were collected. Primary outcomes were mortality and aneurysm-related mortality (ARM). Secondary outcomes were change in aneurysm sac size, endoleak status, major adverse events, and reintervention. Overall, mean age was 75 years, 82% were Caucasian, and 90% of cases were elective. Urgent use of EVAR increased from 7% in the first 5 years to 12% in the latter 5 years of the study. Mean aneurysm size was 5.8 cm. Patients were monitored for an average of 3 years (range, 1-11 years); 8% were lost to follow-up. Intraoperatively, 5% of patients required adjunctive maneuvers for endoleak, fixation, or flow-limiting issues. The 30-day mortality rate was 1.2%, and the perioperative morbidity rate was 6.6%. Intraoperative type I and II endoleaks were uncommon (2.3% and 9.3%, respectively.) Life-table analysis at 5 years demonstrated excellent overall survival of 66% and freedom from ARM of 97%. Postoperative endoleak occurred in 30% of patients and was associated with an increase in sac size over time (Fig). Finally, the total reintervention rate was 15%, including 91 (5%) revision EVARs. The overall major adverse event rate was 8% and decreased significantly from 12.3% in the first 5 years to 5.6% in the second 5 years of the study (P < .001). Overall, ARM was worse in patients with postoperative endoleak (4.1% vs 1.8%, P < .01) or undergoing reintervention (7.6% vs 1.6%, P < .001). Results from a real-world EVAR registry in an integrated health care system demonstrate favorable perioperative outcomes and excellent long-term clinical efficacy. However, postoperative endoleak and need for reintervention continue to be challenging problems for patients after EVAR.