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Midterm Outcomes and Aneurysm Sac Dynamics Following Fenestrated Endovascular Aneurysm Repair after Previous Endovascular Aneurysm Repair.
Sulzer, Titia A L; de Bruin, Jorg L; Rastogi, Vinamr; Boer, Gert Jan; Mesnard, Thomas; Fioole, Bram; Rijn, Marie Josee van; Schermerhorn, Marc L; Oderich, Gustavo S; Verhagen, Hence J M.
Afiliación
  • Sulzer TAL; Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; The University of Texas Health Science Centre at Houston, McGovern Medical School, Houston, TX, USA. Electronic address: titiasulzer@gmail.com.
  • de Bruin JL; Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
  • Rastogi V; Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
  • Boer GJ; Department of Vascular Surgery, Maasstad Hospital Rotterdam, The Netherlands.
  • Mesnard T; The University of Texas Health Science Centre at Houston, McGovern Medical School, Houston, TX, USA.
  • Fioole B; Department of Vascular Surgery, Maasstad Hospital Rotterdam, The Netherlands.
  • Rijn MJV; Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
  • Schermerhorn ML; Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
  • Oderich GS; The University of Texas Health Science Centre at Houston, McGovern Medical School, Houston, TX, USA.
  • Verhagen HJM; Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Eur J Vasc Endovasc Surg ; 67(6): 886-893, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38301871
ABSTRACT

OBJECTIVE:

Fenestrated endovascular aneurysm repair (FEVAR) is a feasible option for aortic repair after endovascular aneurysm repair (EVAR), due to improved peri-operative outcomes compared with open conversion. However, little is known regarding the durability of FEVAR as a treatment for failed EVAR. Since aneurysm sac evolution is an important marker for success after aneurysm repair, the aim of the study was to examine midterm outcomes and aneurysm sac dynamics of FEVAR after prior EVAR.

METHODS:

Patients undergoing FEVAR for complex abdominal aortic aneurysms from 2008 to 2021 at two hospitals in The Netherlands were included. Patients were categorised into primary FEVAR and FEVAR after EVAR. Outcomes included five year mortality rate, one year aneurysm sac dynamics (regression, stable, expansion), sac dynamics over time, and five year aortic related procedures. Analyses were done using Kaplan-Meier methods, multivariable Cox regression analysis, chi square tests, and linear mixed effect models.

RESULTS:

One hundred and ninety-six patients with FEVAR were identified, of whom 27% (n = 53) had had a prior EVAR. Patients with prior EVAR were significantly older (78 ± 6.7 years vs. 73 ± 5.9 years, p < .001). There were no significant differences in mortality rate. FEVAR after EVAR was associated with a higher risk of aortic related procedures within five years (hazard ratio [HR] 2.6; 95% confidence interval [CI] 1.1 - 6.5, p = .037). Sac dynamics were assessed in 154 patients with available imaging. Patients with a prior EVAR showed lower rates of sac regression and higher rates of sac expansion at one year compared with primary FEVAR (sac expansion 48%, n = 21/44, vs. 8%, n = 9/110, p < .001). Sac dynamics over time showed similar results, sac growth for FEVAR after EVAR, and sac shrinkage for primary FEVAR (p < .001).

CONCLUSION:

There were high rates of sac expansion and a need for more secondary procedures in FEVAR after EVAR than primary FEVAR patients, although this did not affect midterm survival. Future studies will have to assess whether FEVAR after EVAR is a valid intervention, and the underlying process that drives aneurysm sac growth following successful FEVAR after EVAR.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma de la Aorta Abdominal / Implantación de Prótesis Vascular / Procedimientos Endovasculares Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Eur J Vasc Endovasc Surg Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma de la Aorta Abdominal / Implantación de Prótesis Vascular / Procedimientos Endovasculares Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Eur J Vasc Endovasc Surg Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido