Long-term outcomes and interventions of postoperative type 1a endoleak following elective endovascular aortic aneurysm repair
| Autor: | Graham W. Long, Christine L. Eden, Diane Studzinski, Matthew Major, Rose E. Callahan, O. William Brown |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Endoleak medicine.medical_treatment Psychological intervention Kaplan-Meier Estimate Endovascular aneurysm repair Blood Vessel Prosthesis Implantation Risk Factors Interquartile range Long term outcomes Humans Medicine Aorta Abdominal Aged Retrospective Studies Aged 80 and over Aortic aneurysm repair business.industry Incidence Incidence (epidemiology) Endovascular Procedures medicine.disease Abdominal aortic aneurysm Surgery Treatment Outcome Elective Surgical Procedures Cohort Female Stents Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal Follow-Up Studies |
| Zdroj: | Journal of Vascular Surgery. 75:136-143.e1 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2021.07.122 |
| Popis: | This study evaluated the incidence and long-term outcomes of postoperative type 1a endoleak (PT1a) following endovascular aortic aneurysm repair (EVAR).A retrospective review of consecutive aortoiliac EVARs performed at a single institution from June 2006 to June 2012 was conducted. Patients with PT1a were identified by postoperative imaging and compared with those who did not develop a PT1a. Late outcomes were also studied of a subset of patients with PT1a who had persistent intraoperative type 1a endoleak (iT1a) on completion angiogram during EVAR that had resolved on initial follow-up imaging.Three hundred eighty-nine patients underwent EVAR with median follow-up of 87 months (interquartile range, 64-111 months). The incidence of PT1a was 8.2% (n = 32) with a median follow-up of 74 months (interquartile range, 52-138 months). Compared with the total cohort, those who developed PT1a were statistically more likely to be female (32% vs 17%; P = .03) and have a higher all-cause mortality (71% vs 40%; P .01) and aneurysm-related mortality (15.6% vs 1.7%; P .01). Median time to presentation was 52 months. Of the 32 patients with PT1a, five (15.6%) presented with aortic rupture, of which three underwent extension cuff placement, one had open graft explant, and one declined intervention. Six patients in total (18.7%) declined intervention; five of these died of nonaneurysmal causes and one remains alive. Of the 26 patients with PT1a who had intervention, 21 (80.7%) showed resolution of PT1a, and five (19.2%) had recurrence. For patients with recurrent PT1a, two had resulting aneurysm-related mortality, two endoleaks resolved after relining with an endograft, and one patient declined intervention but remains alive. Patients with PT1a who had intervention with resolution showed no significant difference in median survival estimates (140.0 months) compared with the remaining EVAR cohort (120.0 months; P = .80). Within the PT1a cohort, 6 (18.7%) had also experienced iT1a with a mean time to presentation of the late PT1a of 45 months. iT1a was associated with a significantly increased likelihood of developing a PT1a (P .01) and decreased median survival (P .01), but there was no known aneurysm-related mortality.Development of PT1a following elective EVAR is associated with increased all-cause and aneurysm-related mortality and presents an average of 52 months postoperatively. This underscores the importance of long-term surveillance. Patients with PT1a who had a successful intervention showed no significant difference in median survival. Those with iT1a had a higher risk for PT1a compared with the EVAR cohort overall and had decreased median survival, without increased aneurysm-related mortality. |
| Databáze: | OpenAIRE |
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