Acceptable Reintervention Rates Research Articles

Situación Fallot reparada en la edad adulta: resultados de 3 décadas de experiencia

IntroductionWe define “Fallot situation” as the existence of significant ventricular septal defect and right ventricular outflow obstruction. Survival into adulthood is extremely rare without complete surgical repair. We present our experience operating these adults. MethodsWe consider complete surgical repair in Fallot adult patients if they have pulmonary arteries with adequate size. Retrospective study: 45 Fallot patients operated from 1993 to 2022 in our adult congenital heart unit. Statistical analysis: SPSS® 20.0. ResultsMean age: 37±13 years, 53% male, 18% prior palliation. Principal diagnosis: double chamber right ventricle+ventricular septal defect (60%), tetralogy of Fallot (27%). NYHA functional class: i 31%, ii 38%, iii 31%. Arrhythmia 20%. Mean hematocrit: 48±10%. Associated left pulmonary artery agenesis 7%, severe aortic regurgitation 7%. Main surgical indication was pulmonary stenosis 98%. Additional tests showed high gradients between the right ventricle and pulmonary artery, and good biventricular function. Surgeries were performed by median sternotomy with cardiopulmonary bypass, moderate hypothermia and aortic clamp. Ventricular septal defect was closed through the right atrium (71%). Reconstruction of the right ventricle outflow tract was done by preserving the pulmonary valve (80%), interposing bioprosthesis (16%), and using transannular patch (4%). Associated surgery (18%): tricuspid (one), aortic (6), anomalous pulmonary venous drainage (one). Inhospital mortality: one patient (2,2%). Mean follow-up: 8.9±7.6 years. Late mortality: 2 patients (4.5%). Reintervention: 7 patients (15%) because of residual lesions (3 percutaneous, 5 surgical). Nowadays, functional class: i 68%, ii 28%, iii 4%; sinus rhythm 83%. ConclusionsComplete surgical repair in adulthood of Fallot patients achieves clinical improvement by eliminating the cyanosis, closing intracardiac shunts, and decreasing right ventricular pressure overload. Our results are excellent with good rates of pulmonary annulus preservation, low mortality and acceptable reintervention rate in the follow up.

Outcomes of multibranched off-the-shelf stent graft in elective and urgent/emergent repair of complex aortic aneurysms with narrow internal aortic lumen

ObjectivesTo assess the outcomes of Cook t-Branch off-the-shelf multibranched stent graft in the treatment of complex aortic aneurysms with narrow internal aortic lumen. MethodsBetween 2016 and 2020, 48 patients (mean age, 73 years) underwent elective or urgent or emergent Cook t-Branch implantation for thoracoabdominal or para/juxtarenal aortic aneurysms in two Italian vascular centers. Among these, 20 patients presented a paravisceral or pararenal luminal diameter of less than 25 mm. Major clinical and radiologic outcomes of patients with narrow aortic lumen were compared with patients with a larger lumen in a multicenter, nonrandomized, retrospective fashion. ResultsThe in-hospital mortality was 10% (5% in the elective setting). Spinal cord ischemia occurred in 6% of the cases. During a mean follow-up of 18 months (range, 1-63 months), late t-Branch procedure-related mortality and the need for reintervention was 0% and 12%, respectively. Comparing the outcomes of patients with large internal aortic lumen (group 1) with patients with small lumen (group 2), no significant difference was found regarding fluoroscopy time (P = .3); technical success (P = 1); early (P = .4) and late (P = 1) mortality; spinal cord ischemia (P = .2); bowel ischemia (P = .5); renal (P = .7), cardiac (P = 1), and respiratory complications (P = 1); reintervention rate (P = 1); and primary patency rate of stented target vessels (P = 1). ConclusionsThe use of the Cook t-Branch in our experience was safe and effective in the treatment of complex aortic aneurysms regardless the caliber of the aortic lumen. With all the limitations of a small sample size, this approach has demonstrated to be feasible when maneuverability is decreased, with low mortality and morbidity, and acceptable reintervention rates. Perioperative mortality remains closely related to clinical presentation. Large-scale studies are needed to confirm these results.

Neonates With Right Aortic Arch Requiring Arch Reconstruction: A Single-Institution Experience

BackgroundReconstruction of a right aortic arch is rarely required in the newborn period and has rarely been reported. MethodsAll patients who underwent a right aortic arch repair in the neonatal period from a single institution were retrospectively reviewed. The primary outcome measures included survival, complications, and reintervention. ResultsBetween 1984 and 2020, 15 patients were identified. Nine patients (60%) presented with an interrupted aortic arch, 5 with a hypoplastic arch (33%), and 1 with anomalous origin of the brachiocephalic vessels (7%). All patients had associated complex congenital heart disease. Median age at surgery was 6 days (range, 2-29 days); median weight was 3.11 kg (range, 2.5-4.18 kg). Genetic syndromes were prevalent and 77% of interrupted aortic arch patients had DiGeorge syndrome. Surgical techniques included end-to-side (27%), end-to-end (27%), or side-to-side anastomosis (13%) and placement of an interposition graft (7%); 65% required patch augmentation. Median intensive care unit and total hospital length of stay were 20 days (range, 7-92 days) and 28 days (range, 10-240 days), respectively. At a median follow-up of 3.97 years (range, 0.19-36 years), 13 of 15 patients were alive (87%). We found vocal cord paralysis in 27%, hemidiaphragm paralysis in 13%, and considerable airway compression in 27%. Overall, 27% patients required reintervention on the aortic arch: 2 surgical and 2 percutaneous balloon dilation. ConclusionsRight aortic arch reconstruction in the newborn period is rare and associated with complex lesions with an acceptable reintervention rate.

Ultrasound-guided high intensity focused ultrasound ablation for uterine fibroids: long-term outcomes and factors affecting local recurrence

Objective To assess the long-term outcomes and the factors affecting local recurrence of uterine fibroids after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation. Materials and methods 629 patients with a solitary uterine fibroid smaller than 10 cm in diameter treated with USgHIFU at our institutes between January 2011 and December 2016 were retrospectively analyzed. The patients were requested to take pre-HIFU and one day post-HIFU MRI. The patients were asked to return to the hospital every 3 months until January 2020, for imaging evaluation and to check on improvement in symptoms. Results Five hundred and thirty-six patients completed follow-up according to our protocol. The median follow-up time was 69 (interquartile range: 48 to 89) months. Among them, local recurrence was detected in 110 patients. 18 (16.4%) patients required additional treatment between 12 and 24 months after USgHIFU treatment, 59 (53.6%) patients required additional treatment 24 months after USgHIFU. Therefore, in total, 77 patients required additional treatment, of which 32 received USgHIFU and 45 underwent myomectomy. The median non-perfused volume (NPV) ratio in patients with recurrence was 73%, compared to 89% among patients without recurrence. Multivariate analysis showed that NPV ratio, maximum fibroid diameter and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after USgHIFU treatment. Conclusions Achievement of NPV ratio higher than 70% has led to acceptable re-intervention rate during the follow-up period after USgHIFU. NPV ratio, maximum fibroid diameter, and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after USgHIFU treatment.

The Focused Ultrasound Myoma Outcome Study (FUMOS); a retrospective cohort study on long-term outcomes of MR-HIFU therapy

Since 2004, uterine fibroids have been treated with MR-HIFU, but there are persevering doubts on long-term efficacy to date. In the Focused Ultrasound Myoma Outcome Study (FUMOS), we evaluated long-term outcomes after MR-HIFU therapy, primarily to assess the reintervention rate. Data was retrospectively collected from 123 patients treated with MR-HIFU at our hospital from 2010 to 2017. Follow-up duration and baseline (MRI) characteristics were retrieved from medical records. Treatment failures, adverse events, and the nonperfused volume percentage (NPV%) were determined. Patients received a questionnaire about reinterventions, recovery time, satisfaction, and pregnancy outcomes. Restrictive treatment protocols were compared with unrestrictive (aiming for complete ablation) treatments. Subgroups were analyzed based on the achieved NPV < 50 or ≥ 50%. Treatment failures occurred in 12.1% and the number of adverse events was 13.7%. Implementation of an unrestrictive treatment protocol significantly (p = 0.006) increased the mean NPV% from 37.4% [24.3-53.0] to 57.4% [33.5-76.5]. At 63.5 ± 29.0months follow-up, the overall reintervention rate was 33.3% (n = 87). All reinterventions were performed within 34months follow-up, but within 21months in the unrestrictive group. The reintervention rate significantly (p = 0.002) decreased from 48.8% in the restrictive group (n = 43; follow-up 87.5 ± 7.3months) to 18.2% in the unrestrictive group (n = 44; follow-up 40.0 ± 22.1months). The median recovery time was 2.0 [1.0-7.0] days. Treatment satisfaction rate was 72.4% and 4/11 women completed family planning after MR-HIFU. The unrestrictive treatment protocol significantly increased the NPV%. Unrestrictive MR-HIFU treatments led to acceptable reintervention rates comparable to other reimbursed uterine-sparing treatments, and no reinterventions were reported beyond 21months follow-up. • All reinterventions were performed within 34months follow-up, but in the unrestrictive treatment protocol group, no reinterventions were reported beyond 21months follow-up. • The NPV% was negatively associated with the risk of reintervention; thus, operators should aim for complete ablation during MR-guided HIFU therapy of uterine fibroids. • Unrestrictive treatments have led to acceptable reintervention rates after MR-guided HIFU therapy compared to other reimbursed uterine-sparing treatments.

Outcomes of Open Repair, Fenestrated Stent Grafting, and Chimney Grafting in Juxtarenal Abdominal Aortic Aneurysm: Is It Time for a Randomized Trial?

The well-established, gold standard treatment for juxtarenal abdominal aortic aneurysms (JAAAs) is open repair (OR). However, endovascular treatment with fenestrated or chimney grafts has been increasingly performed in the past decade. This study compared the outcomes of OR with 2 endovascular methods in JAAA. We retrospectively reviewed consecutive patients with JAAA who underwent OR (n=32), repair with fenestrated stent grafts (fenestrated endovascular aortic aneurysm repair [FEVAR], n=20), or chimney grafts (Ch-EVAR, n=23) during the period from January 2011 to December 2016 at a single center. Our primary end point was perioperative mortality. Secondary end points included renal function impairment, new-onset dialysis, procedural details, and postoperative complications. Kaplan-Meier analysis was used to estimate freedom from late reintervention, primary patency of target vessel stent grafts, and overall survival. There were no significant differences between groups in baseline characteristics. Perioperative mortality was similar in all the 3 groups (3.1% (1/32) in the OR group, 0% in the FEVAR group, and 4.3% (1/23) in the Ch-EVAR group. Mean follow-up duration was 36.7months (range 1-75months). There were no significant differences between groups regarding any of the secondary end points, except for blood loss (which was significantly greatest in the OR group), and there was no significant difference in overall survival. Estimated target vessel stent patency at 1 and 4years was 93.8% and 93.8% in the FEVAR group, and 89.5% and 89.5% in the Ch-EVAR group. There was no significant difference between groups in estimated freedom from late reintervention (96.4% in the OR group, 77.2% in the FEVAR group, and 82.3% in the Ch-EVAR group). Open surgery is an acceptable and effective treatment for JAAA. However, FEVAR and Ch-EVAR also showed high technical success rates and low perioperative mortality, with acceptable reintervention rates during follow-up.

Valve-sparing root replacement for freestanding pulmonary autograft aneurysm after the Ross procedure

ObjectiveAutograft dilatation is the main long-term complication following the Ross procedure using the freestanding root replacement technique. We reviewed our 25-year experience with the Ross procedure with a special emphasis on valve-sparing reoperations. MethodsFrom 1991 to 2016, 153 patients (29.6 ± 16.6 years; 29.4% pediatric) underwent a Ross operation at our institution with implantation of the autograft as freestanding root replacement. The follow-up is 98.7% complete with a mean of 12.2 ± 5.5 years. ResultsMortality at 30-days was 2.0%. Echocardiography documented no or trivial aortic regurgitation in 99.3% of the patients at discharge. Survival probability at 20 years was 85.4%. No case of autograft endocarditis occurred. Autograft deterioration rate was 2.01% per patient-year, and freedom from autograft reoperation was 75.3% at 15 years. A reoperation for autograft aneurysm was required in 35 patients (22.9%) at a mean interval of 11.1 ± 4.6 years after the Ross procedure. A valve-sparing root replacement was performed in 77% of patients, including 10 David and 17 Yacoub procedures with no early mortality. Three patients required prosthetic valve replacement within 2 years after a Yacoub operation. At latest follow-up, 92% of all surviving patients still carry the pulmonary autograft valve. Freedom from autograft valve replacement was 92.1% at 15 years. ConclusionsUsing the David or Yacoub techniques, the autograft valve can be preserved in the majority of patients with root aneurysms after the Ross procedure. Reoperations can be performed with no early mortality, a good functional midterm result, and an acceptable reintervention rate.

Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery.

Background:Native aortic coarctation in young infants can be treated surgically or with balloon angioplasty, although the latter approach remains controversial. We sought to compare midterm outcomes of balloon and surgical coarctoplasty at our center and to review the current practices in literature.Methods:The study design was a retrospective record review. Patients with coarctation aged <1 year who underwent balloon or surgical coarctoplasty at our center (January 2010–January 2016) with >6-month post-procedure follow-up were studied. Patients with significant arch hypoplasia or interruption, long-segment coarctation, and associated intracardiac lesions were excluded from the study. Clinical, echocardiographic, and procedural details were recorded at initial presentation and follow-up. Need for reintervention was noted.Results:Out of a total of 75 patients, 28 underwent balloon (Group A) and 47 underwent surgical coarctoplasty (Group B). There were two deaths in Group B (mortality 4.2%) and none in Group A. In neonates, 63.6% of Group A and 17.4% of Group B patients required reintervention (P = 0.007). Beyond the neonatal age, 29.4% of Group A and 41.6% of Group B patients required reintervention (not statistically significant). On univariate analysis, residual coarctation on predischarge echocardiogram was the only significant predictor of reintervention (P = 0.04). On Kaplan–Meier analysis, with neonatal presentation, freedom from reintervention in Group B was significantly higher than Group A (P = 0.028).Conclusion:In neonates with native aortic coarctation, surgery unequivocally yields better immediate and midterm results and is the preferred treatment modality. In older infants, balloon coarctoplasty has good early and midterm outcomes with acceptable reintervention rates and should be considered a viable alternative to surgery, especially in critical patients with high surgical risk.

Mid-term Outcomes of Endovenous Laser Ablation in Patients with Active and Healed Venous Ulcers: A Follow-up Study

Objectives The aim of this study was to assess the mid-term ulcer recurrence rate in patients with healed or active venous ulcers treated with endovenous laser ablation (EVLA) for incompetent superficial axial veins and to search for possible risk factors for non-healing and recurrence. Methods Consecutive patients treated with EVLA because of a healed or active venous ulcer between 2006 and 2013 were identified in the medical records and quality registry and invited to follow-up, including clinical history, study examination, Duplex ultrasound scanning, ankle brachial pressure, photoplethysmography, venous clinical severity score (VCSS), and health related quality of life (HRQoL) measured with EQ5D. Of 228 patients, 170 (195 legs) fulfilled the inclusion criteria. Twenty patients were interviewed by phone, 27 were unreachable and 11 were excluded. Univariate and multivariate regression analyses were performed to identify possible risk factors for recurrence. Results The mean follow-up time was 41 months (range 14–89 months). The average age was 66.6 years (range 36–87 years). All 86 legs operated on for an active ulcer had this ulcer healed sometime between the operation and the study examination, but thereafter it recurred in 14 patients (16%). In 109 legs operated on for a healed ulcer, the ulcer recurred in 17 legs (16%). Complications such as permanent sensory loss were seen in 16 legs (8%) and deep venous thrombosis in two legs (1%). Thirty legs (15%) were re-treated for superficial venous incompetence (SVI). Reduced ankle mobility was a risk factor for recurrence in both univariate and multivariate analysis ( p =.048). Conclusions These midterm results demonstrate that endovenous laser ablation of SVI in patients with healed or active venous ulcers achieves good healing and low ulcer recurrence rates, with a low rate of complications and an acceptable re-intervention rate.

Long-Term Outcome of the GORE EXCLUDER AAA Endoprosthesis for Treatment of Infrarenal Aortic Aneurysms

PurposeTo evaluate long-term outcome of GORE EXCLUDER AAA Endoprosthesis (W.L. Gore & Associates, Inc, Flagstaff, Arizona) for elective treatment of infrarenal aortic aneurysms and to evaluate performance of different generations of the device. Materials and MethodsA retrospective analysis was performed of 248 patients undergoing elective endovascular aneurysm repair with the GORE EXCLUDER between January 2000 and December 2015 in 2 hospitals. Primary endpoint was reintervention-free survival. Secondary endpoints were technical success, overall survival, rupture-free survival, endoleaks, sac diameter change (> 5 mm), limb occlusion, and migration (> 5 mm). Median follow-up time was 26 months (range, 1–190 months). ResultsAssisted primary technical success was 96.8%. Reintervention-free survival for 5 and 10 years was 85.2% and 75.6%, respectively. Independent risk factors for reintervention were technical success (P < .001), type I endoleak (P < .001), and type II endoleak (P = .003). Late adverse events requiring reintervention included rupture (0.4%), limb occlusion (0.4%), and stent migration (0.4%). Type Ia (4.8%), Ib (2.8%), II (35.9%), and V (6.5%) endoleaks were reported throughout follow-up. Sac growth was more prevalent with the original GORE EXCLUDER compared with the low permeability GORE EXCLUDER (P = .001) and in the presence of type I, II, and V endoleaks (P < .05). Three conversions (1.2%) were performed. Overall survival at 5 and 10 years was 68.4% and 49.0%, with no reported aneurysm-related deaths. ConclusionsTreatment with the GORE EXCLUDER is effective with acceptable reintervention rates in the long-term and few device-related adverse events or ruptures up to 10 years. Observed late adverse events and new-onset endoleaks emphasize the need for long-term surveillance.

Outcome comparison between open and endovascular management of axillosubclavian arterial injuries

Endovascular repair (ER) of axillosubclavian arterial injuries is a minimally invasive alternative to open repair (OR). The purpose of this study was to compare the outcomes of ER vs OR. A retrospective study was performed of patients who sustained axillosubclavian arterial injuries admitted to two high-volume academic trauma centers between 2003 and 2013. Patients undergoing ER and OR were matched according to 25 different demographic and clinical variables in a 1:3 ratio using propensity scores. The primary outcome was in-hospital mortality. Secondary outcomes were complications and length of stay. Among 153 patients (79.7% male; mean age, 32.7 ± 15.9 years) who sustained axillosubclavian arterial injuries, 18 (11.8%) underwent ER and 135 (88.2%) had OR. Matched cases (ER, n = 18) and controls (OR, n = 54) had similar demographic and clinical data, such as age, gender, admission systolic blood pressure and Glasgow Coma Scale score, body Abbreviated Injury Scale scores, Injury Severity Score, and transfusion requirements. Patients undergoing ER had significantly lower in-hospital mortality compared with patients undergoing OR (5.6% vs 27.8%; P = .040; odds ratio, 0.7; 95% confidence interval, 0.6-0.9). Similarly, patients undergoing ER had substantially lower rates of surgical site infections and a trend toward lower rates of sepsis. Outpatient follow-up was available in 88.2% (n = 15) of the patients at a median time of 8 months (1-30 months). Two ER patients required open reintervention for stent-related complications (one for a type Ia endoleak and another for stent thrombosis). In our experience with axillosubclavian arterial injuries, ER was associated with improved mortality and lower complication rates. Patient follow-up demonstrates an acceptable reintervention rate after ER. Further multicenter prospective evaluation is warranted to determine long-term outcomes.

European multicenter experience with valve-sparing reoperations after the Ross procedure

BackgroundAutograft valve preservation at reoperation may conserve some of the advantages of the Ross procedure. However, results of long-term follow-up are lacking. In this retrospective multicenter study, we present our experience with valve-sparing reoperations after the Ross procedure, with a focus on long-term outcome. MethodsA total of 86 patients from 6 European centers, who underwent valve-sparing reoperation after the Ross procedure between 1997 and 2013, were included in the study. ResultsReoperation was performed a median of 9.1 years after the Ross procedure in patients with a median age of 38.4 years (interquartile range: 27.1-51.6 years). Preoperative severe autograft regurgitation (grade ≥3) was present in 46% of patients. In-hospital mortality was 1%. During a median follow-up of 4.3 years, 3 more patients died of noncardiac causes, resulting in a cumulative survival at 8 years of 89% (95% confidence interval: 65%-97%). Fifteen patients required a reintervention after valve-sparing reoperation, mostly owing to prolapse or retraction of autograft cusps. Freedom from reintervention was 76% (95% confidence interval: 57%-87%) at 8 years. The reintervention hazard was increased in patients who had isolated and/or severe aortic regurgitation at valve-sparing reoperation. In patients without reintervention after valve-sparing autograft reoperation (n = 63), severe aortic regurgitation was present in 3% at last follow-up. ConclusionsValve-sparing autograft reoperations after the Ross procedure carry a low operative risk, with acceptable reintervention rates in the first postoperative decade. Patients with isolated and/or severe autograft regurgitation have an increased hazard of reintervention after valve-sparing reoperation; for these patients, careful preoperative weighing of surgical options is required.

Bovine Jugular Vein Conduit for Right Ventricular Outflow Tract Reconstruction: Evaluation of Risk Factors for Mid-Term Outcome

The bovine jugular vein conduit (Contegra [Medtronic, Inc, Minneapolis, MN]) is one option for right ventricular outflow tract reconstruction. We examined the effect of patient age, conduit size, hemodynamics, and cardiac malformation on early and mid-term outcome. Seventy-eight bovine jugular vein implantations were performed over 5 years. Follow-up averaged 31 +/- 17 months. Risk factor and adverse event analyses for graft dysfunction were performed by multivariate logistic regression and Kaplan-Meier analysis. There was no early mortality. Two late deaths occurred after 9 and 15 months. Early postoperative echocardiography revealed bovine jugular vein regurgitation greater than 2+ in 10 patients, all of which had conduit dilatation, had received a 12-mm conduit, and had a right-ventricular-to-left ventricular pressure ratio greater than 0.6. Two additional patients had severe conduit incompetence develop at the 2-year follow-up. During follow-up, mean gradients increased from 15 to 23 mm Hg (p = 0.03) and stenosis at the distal anastomosis occurred in 25% of patients. Percutaneous interventions were performed in 19 patients (24.4%). Conduit exchange was required in 10 patients (12.8%) after a mean of 14.9 months for severe graft incompetence (8 patients) and progressive supravalvular stenosis (2 patients). Freedom from reoperation was 77.6% and 59.3% at 1 and 4 years for patients less than 1 year of age compared with 93.5% and 87.4% for patients older than 1 year of age (p < 0.001). Risk factors for reoperation were age less than 1 year, correction of truncus arteriosus, conduit size of 12 mm, and persistently elevated right-ventricular-to-left ventricular pressure ratio greater than 0.6 (p = 0.001 each). Bovine jugular vein implantation is associated with low reoperation and acceptable reintervention rate in patients older than 1 year of age. In infants with persistently elevated right ventricular pressure, reoperation rate was high and had to be compared with other established surgical options.

Endovascular Therapy of Inflammatory Aortic Aneurysms:A Meta-Analysis

To report a meta-analysis of results from endovascular aneurysm repair (EVAR) of inflammatory aortic aneurysms (IAA). A comprehensive literature review was performed to identify all studies reporting the results of EVAR in patients with IAA. To be included in the analysis, an article had to provide a minimum follow-up of 6 months, information about primary technical success, details of immediate and long-term complications, and evaluation of at least one of the basic outcome criteria: changes in aneurysm sac diameter, periaortic fibrosis (PAF), and/ or renal impairment. All studies were reviewed by 2 independent observers for the inclusion criteria. Data were retrieved on the technical and clinical success, outcome criteria, mortality in follow-up, and reinterventions from 14 articles selected from among 701 initially identified. The 14 articles encompassed 46 patients (45 men [97.8%]; mean age 65 years, range 59-75) with a mean follow-up of 18 months after endovascular repair of IAAs located in the abdominal aorta. The primary technical success rate was 95.6% (44/46) and the 30-day clinical success rate was 93.4% (43/46). The median aneurysm sac diameter regression was 11 mm. Of 43 patients with PAF prior to the intervention, 22 (51.2%) patients showed complete regression, 18 (41.8%) remained unchanged, and 3 (7.0%) showed progression after EVAR. Renal impairment disappeared in 11 (45.8%) of 24 patients. Reinterventions were reported in 8 patients. The procedure-related and follow-up mortality rates were 0% and 13.0%, respectively. EVAR of IAA is feasible, excludes the aneurysm effectively, and reduces PAF and renal impairment in most patients with very low periprocedural and midterm mortality and an acceptable reintervention rate.