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RS13. Standard Endovascular Aneurysm Repair in Patients With Wide Proximal Aneurysm Necks Is Associated With Increased Risk of Adverse Events
JOURNAL OF VASCULAR SURGERY June Supplement 2016
146S Abstracts
RS13. RS13 Standard Endovascular Aneurysm Repair in Patients With Wide Proximal Aneurysm Necks Is Associated With Increased Risk of Adverse Events Nelson Gomes Oliveira, MD1, Frederico Bastos Gonçalves, MD, PhD2, Quirina de Ruiter, MS3, Richte Schuurman, MSc4, Frans Moll, MD, PhD3, Jean-Paul de Vries, MD, PhD4, Joost van Herwaarden, MD, PhD3, Hence Verhagen, MD, PhD1. 1Erasmus University Medical Center, Rotterdam, Netherlands; 2Santa Marta Hospital, CHLC, Lisboa, Portugal; 3University Medical Center of Utrecht, Utrecht, Netherlands; 4St. Antonius Hospital, Nieuwegein, Netherlands Objectives: Endovascular aneurysm repair (EVAR) has progressively expanded to treat progressively more challenging anatomies. Although EVAR in patients with large proximal necks has been reported with acceptable results, there is still controversy regarding the midterm outcomes. Our aim is to determine the impact of proximal neck diameter on midterm outcome after EVAR with a single endograft with suprarenal fixation. Methods: A retrospective case-control study was designed using data from a prospective multicenter database. All measurements were obtained using dedicated reconstruction software and center-lumen line reconstruction. Patients who electively underwent standard EVAR with an Endurant stent graft (Medtronic AVE, Santa Rosa, Calif) for a degenerative AAA from January 2008 to December 2012 in three high-volume centers in the Netherlands were included. Patients with a proximal neck diameter $30 mm were compared to the remaining population. Primary end point was freedom from neckrelated adverse events (type IA endoleak, neck-related secondary intervention, endograft migration >10 mm).
Secondary end points were freedom from rupture, type 1A endoleak and neck-related reinterventions. Results: A total of 427 patients were included; of these, 74 patients (17.3%) with a neck diameter $30 mm were compared to a control group of 353 patients. Median follow-up was 3.1 years (1.2-4.7) and 4.1 years (2.7-5.6) for the large-neck and control groups, respectively (P < .001). The two groups did not differ regarding demographics, comorbidities, baseline aneurysm diameter (P ¼ .39), proximal neck length (P ¼ .72), suprarenal angulation (P ¼ .76), or infrarenal angulation (P ¼ .99). Mean stent graft oversizing was 13.2% 6 5.2% and 17.8% 6 8.0% in the large-neck and control groups, respectively (P < .001). The 4-year freedom from neck-related adverse-events estimates were 75% and 95% for the large-neck and control groups, respectively (P < .001; Fig). Proximal neck diameter $30 mm was associated with a fourfold increased risk of neck- related adverse events in a multivariable model (HR, 4.3; 95% CI, 1.9-9.7; P < .001). Type IA endoleaks occurred in 16 patients (3.7%) and were significantly more frequent in patients with large neck diameters (7 [9.5%]; P ¼ .005). Neck-related secondary interventions were performed in 20 patients (4.7%) and were also more common among patients with neck diameters $30 mm (7 [9.5%]; P ¼ .035). Secondary aneurysm rupture occurred in 7 patients but was not associated to large proximal aneurysm neck (P ¼ .82). Conclusions: EVAR in patients with large-diameter necks is associated with an increased risk of neck-related adverse events in midterm follow-up. This may influence the clinical decision regarding choice of repair and towards a more intensive surveillance after EVAR. Author Disclosures: F. Bastos Gonçalves: Nothing to disclose; Q. de Ruiter: Nothing to disclose; J. de Vries: Nothing to disclose; F. Moll: Nothing to disclose; N. Gomes Oliveira: Nothing to disclose; R. Schuurman: Nothing to disclose; J. van Herwaarden: Nothing to disclose; H. Verhagen: Endologix: consulting fees (eg, advisory boards), Medtronic: consulting fees (eg, advisory boards), Philips: speaker’s bureau. RS14 RS14. EVAR Patients Who Are Lost to Follow-Up Have Worse Outcomes Caitlin W. Hicks, MD, MS1, Devin S. Zarkowsky, MD2, Ian C. Bostock, MD, MS3, David H. Stone, MD2, Mahmoud B. Malas, MD, MS4, James H. Black III, MD, FACS1, Jens Eldrup-Jorgensen, MD5, Philip P. Goodney, MD, MS2. 1Johns Hopkins University, Baltimore, Md; 2Dartmouth-Hitchcock Medical Center, Lebanon, NH; 3Dartmouth-Hitchcock Medical Center, Lebanon, Me; 4Johns Hopkins Hospital, Baltimore, Md; 5 Maine Medical Center, Portland, Me
Fig. Kaplan-Meier estimates for freedom from neck-related adverse events.
Objectives: Society for Vascular Surgery practice guidelines recommend 1- and 12-month follow-up with CT imaging for the year after endovascular aortic aneurysm repair (EVAR) to identify endoleaks and aneurysmal enlargement. We describe the incidence, risk factors, and outcomes of EVAR patients who are lost to follow-up (LTF). Methods: All patients undergoing elective EVAR in the Vascular Quality Initiative data set (January 2003-December
146S Abstracts
RS13. RS13 Standard Endovascular Aneurysm Repair in Patients With Wide Proximal Aneurysm Necks Is Associated With Increased Risk of Adverse Events Nelson Gomes Oliveira, MD1, Frederico Bastos Gonçalves, MD, PhD2, Quirina de Ruiter, MS3, Richte Schuurman, MSc4, Frans Moll, MD, PhD3, Jean-Paul de Vries, MD, PhD4, Joost van Herwaarden, MD, PhD3, Hence Verhagen, MD, PhD1. 1Erasmus University Medical Center, Rotterdam, Netherlands; 2Santa Marta Hospital, CHLC, Lisboa, Portugal; 3University Medical Center of Utrecht, Utrecht, Netherlands; 4St. Antonius Hospital, Nieuwegein, Netherlands Objectives: Endovascular aneurysm repair (EVAR) has progressively expanded to treat progressively more challenging anatomies. Although EVAR in patients with large proximal necks has been reported with acceptable results, there is still controversy regarding the midterm outcomes. Our aim is to determine the impact of proximal neck diameter on midterm outcome after EVAR with a single endograft with suprarenal fixation. Methods: A retrospective case-control study was designed using data from a prospective multicenter database. All measurements were obtained using dedicated reconstruction software and center-lumen line reconstruction. Patients who electively underwent standard EVAR with an Endurant stent graft (Medtronic AVE, Santa Rosa, Calif) for a degenerative AAA from January 2008 to December 2012 in three high-volume centers in the Netherlands were included. Patients with a proximal neck diameter $30 mm were compared to the remaining population. Primary end point was freedom from neckrelated adverse events (type IA endoleak, neck-related secondary intervention, endograft migration >10 mm).
Secondary end points were freedom from rupture, type 1A endoleak and neck-related reinterventions. Results: A total of 427 patients were included; of these, 74 patients (17.3%) with a neck diameter $30 mm were compared to a control group of 353 patients. Median follow-up was 3.1 years (1.2-4.7) and 4.1 years (2.7-5.6) for the large-neck and control groups, respectively (P < .001). The two groups did not differ regarding demographics, comorbidities, baseline aneurysm diameter (P ¼ .39), proximal neck length (P ¼ .72), suprarenal angulation (P ¼ .76), or infrarenal angulation (P ¼ .99). Mean stent graft oversizing was 13.2% 6 5.2% and 17.8% 6 8.0% in the large-neck and control groups, respectively (P < .001). The 4-year freedom from neck-related adverse-events estimates were 75% and 95% for the large-neck and control groups, respectively (P < .001; Fig). Proximal neck diameter $30 mm was associated with a fourfold increased risk of neck- related adverse events in a multivariable model (HR, 4.3; 95% CI, 1.9-9.7; P < .001). Type IA endoleaks occurred in 16 patients (3.7%) and were significantly more frequent in patients with large neck diameters (7 [9.5%]; P ¼ .005). Neck-related secondary interventions were performed in 20 patients (4.7%) and were also more common among patients with neck diameters $30 mm (7 [9.5%]; P ¼ .035). Secondary aneurysm rupture occurred in 7 patients but was not associated to large proximal aneurysm neck (P ¼ .82). Conclusions: EVAR in patients with large-diameter necks is associated with an increased risk of neck-related adverse events in midterm follow-up. This may influence the clinical decision regarding choice of repair and towards a more intensive surveillance after EVAR. Author Disclosures: F. Bastos Gonçalves: Nothing to disclose; Q. de Ruiter: Nothing to disclose; J. de Vries: Nothing to disclose; F. Moll: Nothing to disclose; N. Gomes Oliveira: Nothing to disclose; R. Schuurman: Nothing to disclose; J. van Herwaarden: Nothing to disclose; H. Verhagen: Endologix: consulting fees (eg, advisory boards), Medtronic: consulting fees (eg, advisory boards), Philips: speaker’s bureau. RS14 RS14. EVAR Patients Who Are Lost to Follow-Up Have Worse Outcomes Caitlin W. Hicks, MD, MS1, Devin S. Zarkowsky, MD2, Ian C. Bostock, MD, MS3, David H. Stone, MD2, Mahmoud B. Malas, MD, MS4, James H. Black III, MD, FACS1, Jens Eldrup-Jorgensen, MD5, Philip P. Goodney, MD, MS2. 1Johns Hopkins University, Baltimore, Md; 2Dartmouth-Hitchcock Medical Center, Lebanon, NH; 3Dartmouth-Hitchcock Medical Center, Lebanon, Me; 4Johns Hopkins Hospital, Baltimore, Md; 5 Maine Medical Center, Portland, Me
Fig. Kaplan-Meier estimates for freedom from neck-related adverse events.
Objectives: Society for Vascular Surgery practice guidelines recommend 1- and 12-month follow-up with CT imaging for the year after endovascular aortic aneurysm repair (EVAR) to identify endoleaks and aneurysmal enlargement. We describe the incidence, risk factors, and outcomes of EVAR patients who are lost to follow-up (LTF). Methods: All patients undergoing elective EVAR in the Vascular Quality Initiative data set (January 2003-December