Aortic endograft sizing and endoleak, reintervention, and mortality following endovascular aneurysm repair
| Autor: | Yuki Ikeno, Matthew J. Bokamper, Kristofer M. Charlton-Ouw, Emad Zakhary, Great participants, Matthew R. Smeds |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Endoleak Adverse outcomes medicine.medical_treatment 030204 cardiovascular system & hematology Prosthesis Design Risk Assessment Endovascular aneurysm repair Blood Vessel Prosthesis Implantation 03 medical and health sciences symbols.namesake Sex Factors 0302 clinical medicine Risk Factors Cox proportional hazards regression Humans Medicine Registries 030212 general & internal medicine Fisher's exact test Aged Retrospective Studies Aged 80 and over Aortic graft business.industry Endovascular Procedures Female sex medicine.disease Abdominal aortic aneurysm Blood Vessel Prosthesis Surgery Treatment Outcome Retreatment symbols Female Stents Cardiology and Cardiovascular Medicine business Proximal neck Aortic Aneurysm Abdominal |
| Zdroj: | Journal of Vascular Surgery. 74:1519-1526.e2 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2021.04.045 |
| Popis: | Endograft sizing for endovascular abdominal aortic aneurysm repair (EVAR) is not consistent despite published instructions for use (IFU). We sought to identify factors associated with over/undersizing, determine sex influence on sizing, and examine sizing effects on endoleak, reintervention, and mortality by analyzing data obtained from the W.L. GoreAssociates Global Registry for Endovascular Aortic Treatment (GREAT).All patients enrolled in GREAT undergoing EVAR were included for analysis. Proximal/distal aortic landing zones were compared with device implanted to assess sizing as related to IFU. χThere were 3607 EVAR subjects enrolled in GREAT as of March 2020. Of them, 1896 (53%) were within IFU for sizing, 791 (22%) were oversized, 540 (15%) were undersized, and 380 (10%) had both over- and undersized components. Factors predictive of use outside of IFU included female sex (P = .001), non-white race (P = .0003), decreased proximal neck length (P .061), or larger iliac diameters (P .0001). Women were more likely than men to have proximal neck undersizing and iliac limb oversizing, and men were more likely to have iliac limb undersizing. On multivariate analysis, undersizing of the proximal graft was associated with endoleak (hazard ratio [HR], 1.8) and aortic (HR, 60.5) and all-cause (HR, 18.0) mortality. Undersizing of iliac limbs was associated with endoleak (HR, 1.5) and device-related reintervention (HR, 1.4). Iliac limb outside IFU sizing was associated with aortic (HR, 2.6) and all-cause (HR, 1.3) mortality. Proximal and distal oversizing was not associated with adverse outcomes. Female sex was associated with mortality on univariate but not multivariate analysis.Women undergoing EVAR with GORE EXCLUDER abdominal aortic aneurysm Endoprosthesis (W.L. Gore Associates Inc, Flagstaff, Ariz) are more likely to have proximal stent-graft undersizing and iliac limb oversizing, whereas men are more likely to have undersized iliac limbs. Proximal aortic graft undersizing is associated with endoleak and all-cause/aortic mortality, whereas undersizing of iliac limbs is associated with endoleak and device-related reintervention. Oversizing was not associated with adverse outcomes. |
| Databáze: | OpenAIRE |
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