Clinical failures of endovascular abdominal aortic aneurysm repair

Incidence, causes, and management

Jeffery Dattilo, David C. Brewster, Chien Min Fan, Stuart C. Geller, Richard P. Cambria, Glenn M. LaMuraglia, Alan J. Greenfield, Stephen R. Lauterbach, William M. Abbott

    Research output: Contribution to journalArticle

    132 Citations (Scopus)

    Abstract

    Objective: Despite well-documented good early results and benefits of endoluminal stent graft repair of abdominal aortic aneurysm (J Vasc Surg 2002;35:1137-44.)(AAA), the long-term outcome of this method of treatment remains uncertain. In particular, concern exists that late effectiveness and durability are inferior to that of open repair. To determine the incidence and causes of clinical failures of endovascular AAA repair, a 7-year experience with 362 primary AAA endografts was reviewed. Methods: Clinical failures were defined as deaths within 30 days of the procedure, conversions (early and late) to open AAA repair, AAA rupture after endoluminal treatment, or AAA sac growth of more than 5 mm in maximal diameter despite endograft repair. Endoleak status per se was not considered unless it resulted in an adverse event. If clinical problems arose but could be corrected with catheter-based therapies or limited surgical procedures, thereby maintaining the integrity of successful stent graft treatment of the AAA, such cases were considered as primary assisted success and not classified as clinical failures. Results: The average follow-up period was 1.5 years. Six deaths (1.6%) occurred after the procedure, all in elderly patients or patients at high risk. Five patients (1.4%) needed early conversion (immediate, 2 days) to open repair for access problems or technical difficulties with deployment, resulting in an implantation success rate of 98.6%. Eight patients (2.2%) underwent late conversion for a variety of problems, including AAA expansion (n = 4), endograft thrombosis (n = 1), secondary graft infection (n = 2), and rupture at 3 years (n = 1). Rupture occurred in an additional two patients for a total incidence rate of 0.8%. AAA sac growth of greater than 5 mm was observed in 20 patients (5.6%), four of whom have undergone successful catheter-based treatments to date. Overall, 39 patients (10.7%) needed catheter-based (n = 45) or limited surgical (n = 4) reinterventions for a variety of late problems that were successful in 92%. Conclusion: In our 7-year experience, one or more clinical failures of endovascular AAA repair were observed in 31 patients (8.3%). Reinterventions were necessitated in a total of 10.7% of patients but were usually successful in maintaining AAA exclusion and limiting AAA growth. These results emphasize that endovascular repair provides good results and many benefits for most properly selected patients but is not as durable as standard open repair.

    Original languageEnglish (US)
    Pages (from-to)1137-1144
    Number of pages8
    JournalJournal of Vascular Surgery
    Volume35
    Issue number6
    DOIs
    StatePublished - Jan 1 2002

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    Abdominal Aortic Aneurysm
    Incidence
    Rupture
    Catheters
    Transplants
    Stents
    Growth
    Endoleak
    Peritoneal Cavity
    Therapeutics
    Coinfection
    Thrombosis

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Dattilo, J., Brewster, D. C., Fan, C. M., Geller, S. C., Cambria, R. P., LaMuraglia, G. M., ... Abbott, W. M. (2002). Clinical failures of endovascular abdominal aortic aneurysm repair: Incidence, causes, and management. Journal of Vascular Surgery, 35(6), 1137-1144. https://doi.org/10.1067/mva.2002.124627

    Clinical failures of endovascular abdominal aortic aneurysm repair : Incidence, causes, and management. / Dattilo, Jeffery; Brewster, David C.; Fan, Chien Min; Geller, Stuart C.; Cambria, Richard P.; LaMuraglia, Glenn M.; Greenfield, Alan J.; Lauterbach, Stephen R.; Abbott, William M.

    In: Journal of Vascular Surgery, Vol. 35, No. 6, 01.01.2002, p. 1137-1144.

    Research output: Contribution to journalArticle

    Dattilo, J, Brewster, DC, Fan, CM, Geller, SC, Cambria, RP, LaMuraglia, GM, Greenfield, AJ, Lauterbach, SR & Abbott, WM 2002, 'Clinical failures of endovascular abdominal aortic aneurysm repair: Incidence, causes, and management', Journal of Vascular Surgery, vol. 35, no. 6, pp. 1137-1144. https://doi.org/10.1067/mva.2002.124627
    Dattilo, Jeffery ; Brewster, David C. ; Fan, Chien Min ; Geller, Stuart C. ; Cambria, Richard P. ; LaMuraglia, Glenn M. ; Greenfield, Alan J. ; Lauterbach, Stephen R. ; Abbott, William M. / Clinical failures of endovascular abdominal aortic aneurysm repair : Incidence, causes, and management. In: Journal of Vascular Surgery. 2002 ; Vol. 35, No. 6. pp. 1137-1144.
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    abstract = "Objective: Despite well-documented good early results and benefits of endoluminal stent graft repair of abdominal aortic aneurysm (J Vasc Surg 2002;35:1137-44.)(AAA), the long-term outcome of this method of treatment remains uncertain. In particular, concern exists that late effectiveness and durability are inferior to that of open repair. To determine the incidence and causes of clinical failures of endovascular AAA repair, a 7-year experience with 362 primary AAA endografts was reviewed. Methods: Clinical failures were defined as deaths within 30 days of the procedure, conversions (early and late) to open AAA repair, AAA rupture after endoluminal treatment, or AAA sac growth of more than 5 mm in maximal diameter despite endograft repair. Endoleak status per se was not considered unless it resulted in an adverse event. If clinical problems arose but could be corrected with catheter-based therapies or limited surgical procedures, thereby maintaining the integrity of successful stent graft treatment of the AAA, such cases were considered as primary assisted success and not classified as clinical failures. Results: The average follow-up period was 1.5 years. Six deaths (1.6{\%}) occurred after the procedure, all in elderly patients or patients at high risk. Five patients (1.4{\%}) needed early conversion (immediate, 2 days) to open repair for access problems or technical difficulties with deployment, resulting in an implantation success rate of 98.6{\%}. Eight patients (2.2{\%}) underwent late conversion for a variety of problems, including AAA expansion (n = 4), endograft thrombosis (n = 1), secondary graft infection (n = 2), and rupture at 3 years (n = 1). Rupture occurred in an additional two patients for a total incidence rate of 0.8{\%}. AAA sac growth of greater than 5 mm was observed in 20 patients (5.6{\%}), four of whom have undergone successful catheter-based treatments to date. Overall, 39 patients (10.7{\%}) needed catheter-based (n = 45) or limited surgical (n = 4) reinterventions for a variety of late problems that were successful in 92{\%}. Conclusion: In our 7-year experience, one or more clinical failures of endovascular AAA repair were observed in 31 patients (8.3{\%}). Reinterventions were necessitated in a total of 10.7{\%} of patients but were usually successful in maintaining AAA exclusion and limiting AAA growth. These results emphasize that endovascular repair provides good results and many benefits for most properly selected patients but is not as durable as standard open repair.",
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    T1 - Clinical failures of endovascular abdominal aortic aneurysm repair

    T2 - Incidence, causes, and management

    AU - Dattilo, Jeffery

    AU - Brewster, David C.

    AU - Fan, Chien Min

    AU - Geller, Stuart C.

    AU - Cambria, Richard P.

    AU - LaMuraglia, Glenn M.

    AU - Greenfield, Alan J.

    AU - Lauterbach, Stephen R.

    AU - Abbott, William M.

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    Y1 - 2002/1/1

    N2 - Objective: Despite well-documented good early results and benefits of endoluminal stent graft repair of abdominal aortic aneurysm (J Vasc Surg 2002;35:1137-44.)(AAA), the long-term outcome of this method of treatment remains uncertain. In particular, concern exists that late effectiveness and durability are inferior to that of open repair. To determine the incidence and causes of clinical failures of endovascular AAA repair, a 7-year experience with 362 primary AAA endografts was reviewed. Methods: Clinical failures were defined as deaths within 30 days of the procedure, conversions (early and late) to open AAA repair, AAA rupture after endoluminal treatment, or AAA sac growth of more than 5 mm in maximal diameter despite endograft repair. Endoleak status per se was not considered unless it resulted in an adverse event. If clinical problems arose but could be corrected with catheter-based therapies or limited surgical procedures, thereby maintaining the integrity of successful stent graft treatment of the AAA, such cases were considered as primary assisted success and not classified as clinical failures. Results: The average follow-up period was 1.5 years. Six deaths (1.6%) occurred after the procedure, all in elderly patients or patients at high risk. Five patients (1.4%) needed early conversion (immediate, 2 days) to open repair for access problems or technical difficulties with deployment, resulting in an implantation success rate of 98.6%. Eight patients (2.2%) underwent late conversion for a variety of problems, including AAA expansion (n = 4), endograft thrombosis (n = 1), secondary graft infection (n = 2), and rupture at 3 years (n = 1). Rupture occurred in an additional two patients for a total incidence rate of 0.8%. AAA sac growth of greater than 5 mm was observed in 20 patients (5.6%), four of whom have undergone successful catheter-based treatments to date. Overall, 39 patients (10.7%) needed catheter-based (n = 45) or limited surgical (n = 4) reinterventions for a variety of late problems that were successful in 92%. Conclusion: In our 7-year experience, one or more clinical failures of endovascular AAA repair were observed in 31 patients (8.3%). Reinterventions were necessitated in a total of 10.7% of patients but were usually successful in maintaining AAA exclusion and limiting AAA growth. These results emphasize that endovascular repair provides good results and many benefits for most properly selected patients but is not as durable as standard open repair.

    AB - Objective: Despite well-documented good early results and benefits of endoluminal stent graft repair of abdominal aortic aneurysm (J Vasc Surg 2002;35:1137-44.)(AAA), the long-term outcome of this method of treatment remains uncertain. In particular, concern exists that late effectiveness and durability are inferior to that of open repair. To determine the incidence and causes of clinical failures of endovascular AAA repair, a 7-year experience with 362 primary AAA endografts was reviewed. Methods: Clinical failures were defined as deaths within 30 days of the procedure, conversions (early and late) to open AAA repair, AAA rupture after endoluminal treatment, or AAA sac growth of more than 5 mm in maximal diameter despite endograft repair. Endoleak status per se was not considered unless it resulted in an adverse event. If clinical problems arose but could be corrected with catheter-based therapies or limited surgical procedures, thereby maintaining the integrity of successful stent graft treatment of the AAA, such cases were considered as primary assisted success and not classified as clinical failures. Results: The average follow-up period was 1.5 years. Six deaths (1.6%) occurred after the procedure, all in elderly patients or patients at high risk. Five patients (1.4%) needed early conversion (immediate, 2 days) to open repair for access problems or technical difficulties with deployment, resulting in an implantation success rate of 98.6%. Eight patients (2.2%) underwent late conversion for a variety of problems, including AAA expansion (n = 4), endograft thrombosis (n = 1), secondary graft infection (n = 2), and rupture at 3 years (n = 1). Rupture occurred in an additional two patients for a total incidence rate of 0.8%. AAA sac growth of greater than 5 mm was observed in 20 patients (5.6%), four of whom have undergone successful catheter-based treatments to date. Overall, 39 patients (10.7%) needed catheter-based (n = 45) or limited surgical (n = 4) reinterventions for a variety of late problems that were successful in 92%. Conclusion: In our 7-year experience, one or more clinical failures of endovascular AAA repair were observed in 31 patients (8.3%). Reinterventions were necessitated in a total of 10.7% of patients but were usually successful in maintaining AAA exclusion and limiting AAA growth. These results emphasize that endovascular repair provides good results and many benefits for most properly selected patients but is not as durable as standard open repair.

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