Midterm Outcomes of Secondary Procedures Following Endovascular Aneurysm Repair: A Prospective Analysis

BACKGROUND: To evaluate the outcomes of secondary (2^o) procedures after endovascular aneurysm repair (EVAR).
METHODS: From 2002-2008, 1450 patients underwent EVAR and were evaluated by CTA every 6-12 months. Patients with type I and III endoleaks (EL), unexplained endotension, limb occlusion, stentgraft (SG) migration with and without type I endoleak, and aneurysm rupture underwent 2^o interventions. Type II EL at > 6 month without decrease in the aneurysm sac underwent trans-lumbar (TL) embolization. Data was prospectively collected.
RESULTS: Of 1450 elective (n=1362, 94%) and emergent (n=88, 6%) EVAR procedures, 259 (17.9%) patients required addtional procedures over a mean follow-up of 32 months (range 1-84 months). 229 (15.8%) patients required 2^o endovascular (n=200, 87%) and open surgical (n=29, 13%) proceudres (Table 1). 76% (22 of 29 patients) of aneurysm rupture patients were considered lost to follow-up after the intial EVAR. An additional 30 (2.1%) patietns required tertiary (3^o) proceudres including repeat TL embolization (n=12, 0.8%), repeat proximal SG extension for migration (n=11, 0.8%), and elective open surgical repair (n=7, 0.5%). The overall mortality of these 2^o and 3^o procedures was 3.9%, and was highest in the aneurysm rupture group; 15% (4 of 29 patients) (Table 1).
CONCLUSIONS: Our midterm experience indicates that 18% of patients require additional 2^o and 3^o procedures, and vast majority of these patients can be managed by endovascular means with acceptable overall mortality of 3.9%. Most type I EL can be successfully treated by TL embolization. Most patients with delayed aneurysm rupture after EVAR can be successfully managed by endovascular or open surgical repair.