Five-year Experience with Endovascular Aneurysm Repair without Fenestration for Pararenal Aortic Aneurysms: Clinical Efficacy, Reintervention Rates, and Cost-effectiveness Compared with Open Repair in High Deliberate-practice Volume Centers

Objectives Marfan syndrome patients are at risk for aortic degeneration. Repair is traditionally performed with open surgery as this is deemed more durable. Endovascular aneurysm repair remains controversial. We report on the outcomes of Marfan syndrome patients with abdominal aortic aneurysms undergoing endovascular aneurysm repair. Methods The Vascular Quality Initiative registry identified 35,889 patients, including 29 with Marfan syndrome, treated with endovascular aneurysm repair from January 2003 to December 2017. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results Median age was 70.0 years (IQR, 57.0–75.0), and 22 (75.9%) were male. Median aneurysm diameter was 5.3 cm (IQR, 4.9–6.3 cm), with an aortic neck length and diameter of 2.0 cm (IQR, 1.6–2.8 cm) and 2.5 cm (IQR, 2.2–2.8 cm), respectively. Twenty-one (72.4%) patients were asymptomatic, seven (24.1%) symptomatic, and one (3.4%) presented with rupture. Ten (34.5%) patients had prior aortic surgery. Six (20.7%) were unfit for open surgical repair. Length of stay was 2.0 days (IQR, 1.0–3.0 days). Percutaneous femoral access was performed in 15 (51.7%) patients with no complications. A type IA endoleak was present in one (3.4%), type IB in one (3.4%), and type II endoleak in two (6.9%) patients. There were no postoperative pulmonary, cardiac, or neurological complications. In-hospital mortality occurred in one (3.4%) patient who presented with a rupture and had been deemed unfit for open repair. A conversion to open repair was required. The patient expired on post-operative day 0. Early clinical success was achieved in 26 (89.7%) patients. Follow-up was available for 15 (51.7%) patients at a median time of 766 days (IQR, 653–937). There were no reinterventions or mortalities. Change in sac diameter was −0.6 cm (IQR, −1.1 to −0.2 cm), with no type I or III endoleaks. Discussion Endovascular aneurysm repair for patients with Marfan syndrome is feasible, and can be performed safely. Mid-term outcomes suggest this technique is durable. More robust long-term follow-up is needed.

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Long-term Durability of Open Repair of Juxtarenal Abdominal Aortic Aneurysms: A Performance Standard for Fenestrated and Branched Endovascular Aneurysm Repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.07.007 ◽

2011 ◽

Vol 54 (4) ◽

pp. 1225

Author(s):

Shirling Tsai ◽

Mark F. Conrad ◽

Robert S. Crawford ◽

Virendra Patel ◽

Christopher J. Kwolek ◽

...

Keyword(s):

Open Repair ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Performance Standard ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

A Performance

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Endovascular Aneurysm Repair Increases Aortic Arterial Stiffness When Compared to Open Repair of Abdominal Aortic Aneurysms

Vascular and Endovascular Surgery ◽

10.1177/1538574416647503 ◽

2016 ◽

Vol 50 (5) ◽

pp. 317-320 ◽

Cited By ~ 5

Author(s):

Cleona Gray ◽

Patrick Goodman ◽

Stephen A. Badger ◽

M. Kevin O’Malley ◽

Martin K. O’Donohoe ◽

...

Keyword(s):

Arterial Stiffness ◽

Open Repair ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Aneurysm Repair

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Elective endovascular vs. open repair for abdominal aortic aneurysm in octogenarians

Vascular ◽

10.1177/1708538115594967 ◽

2016 ◽

Vol 24 (4) ◽

pp. 348-354 ◽

Cited By ~ 5

Author(s):

Koichi Morisaki ◽

Takuya Matsumoto ◽

Yutaka Matsubara ◽

Kentaro Inoue ◽

Yukihiko Aoyagi ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Operative Mortality ◽

Open Repair ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Elective Repair ◽

Aneurysm Repair ◽

Repair Group

Purpose The purpose of this study was to investigate the operative mortality and short-term and midterm outcomes of treatment of abdominal aortic aneurysm in Japanese patients over 80 years of age. Methods Between January 2007 and December 2011, 207 patients underwent elective repair of infrarenal abdominal aortic aneurysms. Comorbidities, operative morbidity and mortality, midterm outcomes were analyzed retrospectively. Results The average age (endovascular aneurysm repair, 84.4 ± 0.3; open, 82.8 ± 0.3, P < 0.01) and the percentage of hostile abdomen (endovascular aneurysm repair, 22.2%; open repair, 11.1%, P < 0.05) were higher in the endovascular aneurysm repair group. Percentage of outside IFU was higher in open repair (endovascular aneurysm repair, 38.5%; open repair, 63.3%, P < 0.01). The cardiac complication (endovascular aneurysm repair, 0%; open repair, 5.6%, P < 0.01) and length of postoperative hospital stay (endovascular aneurysm repair, 10.3 ± 0.8 days; open, 18.6 ± 1.6 days, P < 0.05) were significantly lower in the endovascular aneurysm repair group. There were no differences in operative mortality (endovascular aneurysm repair, 0%; open, 1.1%, P = 0.43) and the aneurysm-related death was not observed. The rate of secondary interventions (EVAR, 5.1%; open repair, 0%, P < 0.01) and midterm mortality rate were much higher in the endovascular aneurysm repair group. Conclusions Endovascular aneurysm repair is less invasive than open repair and useful for treating abdominal aortic aneurysm in octogenarians; however, open repair can be acceptable treatment in the inappropriate case treated by endovascular aneurysm repair.

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Endovascular Aneurysm Repair versus Open Repair in Patients with Abdominal Aortic Aneurysm

10.1093/med/9780199384075.003.0003 ◽

2017 ◽

Author(s):

F. Ben Pearce ◽

Tze-Woei Tan ◽

Wayne W. Zhang

Keyword(s):

Endovascular Repair ◽

Open Repair ◽

Perioperative Complications ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Study Intervention ◽

Complications And Mortality

This chapter provides a summary of the landmark EVAR Trial 1, which compared endovascular repair of abdominal aortic aneurysms (AAA) with open repair in patients judged to be fit for both open and endovascular repair. Although endovascular AAA (EVAR) repair was associated with lower perioperative complications and mortality than open surgical repair, after 4 years of follow-up the outcomes of the two approaches were similar. Follow-up at 15 years found EVAR had inferior late survival, necessitating lifelong surveillance of EVAR and reintervention if necessary. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

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