Introduction: Endovascular aortic repair (EVAR) is the standard method for AAA repair. This is especially true for elective and ruptured AAAs, where the outcomes of this repair have been extensively studied. Outcomes of symptomatic AAA (sAAA) have been scarcely studied on their own, as they are usually grouped together with asymptomatic AAAs as “intact” or ruptured AAAs as “acute” repairs. The aim of this study is to assess the outcomes of sAAA as compared to asymptomatic AAA (aAAA) repair using the ZenithTM stentgraft system.
Methods: All consecutive patients treated for sAAA and aAAA from 1998 – 2012 at our institution, using the Cook-ZenithTM stentgraft, were included in the study. Patient charts were reviewed to obtain pre-, intra-, and post-operative data. Clinical success was assessed as per the reporting standards. All available imaging was reviewed to assess for causes of clinical failure, including endoleaks, stentgraft migrations and aneurysm expansion amongst others. Life-tables were constructed to assess for overall and late-AAA related survival, clinical success and endoleak freedom.
Results: A total of 681 patients, including 541 (79.4 %) patients underwent elective EVAR for aAAA using the Cook-Zenith stentgraft, while 140 (21.6 %) underwent acute EVAR due to sAAA. Aneurysm diameter was marginally larger pre-operatively for sAAA (61 (52 – 74) mm) compared to aAAA (58 (53 – 66) mm) (p= 0.051). Technical failure rate was almost identical (5.7 % sAAA versus 4.3 % aAAA) in (p= 0.494). 30-day mortality was 6.4 % sAAA versus 1.5 % aAAA (p= 0.003). Re-intervention rates for sAAA were 10 ± 3 %, 22 ± 4 % and 27 ± 5 %, while for aAAA 7 ± 1 %, 19 ± 2 % and 25 ± 2 % at 1, 5 and 10-years post-operatively (p=0.345). Primary, primary assisted and secondary clinical success rates were, at 10-years, 55 ± 5 %, 64 ± 5 % and 72 ± 5 % for sAAA, while for aAAA 58 ± 3 %, 70 ± 3 % and 75 ± 3 %, being significantly different for primary assisted and secondary success (p < 0.05) respectively. Primary and assisted type I/III endoleak freedom, at 10-years, were 84 ± 5 % and 92 ± 3 % for sAAA and 80 ± 5 % and 90 ± 3 % for aAAA, with non-significant (p > 0.05) difference between the groups. Overall survival at 10-years was 33 ± 5 % for sAAA and 32 ± 2 % for aAAA (p=0.979) (Fig. 1). Freedom from late AAA-related death was, for sAAA (N=4, 2.86 %) 98 ± 1 % and 96 ± 2 % at 5-and 10-years, while for aAAA (N=16, 2.35 %) these were 99 ± 1 % and 95 ± 1 % at the same time points (p= 0.938) (Fig. 1).
Conclusion: sAAA demonstrates similar outcomes to aAAA using the ZenithTM stentgraft. Especially with regards to overall survival, freedom from late AAA-related deaths and post-operative re-interventions. Clinical success was low in both groups at 10 years post-operatively, potentially related to increased unfitness to undergo redo procedures to correct causes of failure. The almost quadrupled 30-day mortality associated with sAAA as compared to aAAA may be related to a less extensive pre-operative medical assessment and optimization. To conclude, the similar outcomes of EVAR for sAAA as compared to aAAA are encouraging, with improvement potential with regards to the relatively high 30-day mortality achievable by more aggressive medical optimization of sAAA patients.
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P-128 Abdominal Aortic Diseases
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