Long-Term Outcomes of Endovascular Aneurysm Repair. Can We Reckon upon a Long-Term Result?
Abstract
This article represents the analysis of the long-term outcomes of endovascular treatment of infrarenal aortic aneurysms in 110 patients who underwent endovascular aneurysm repair (EVAR). The age of the patients was 68.5 ± 9.8 years, 104 patients were males. Hypertension was noted in the absolute majority – 101 patients, which accounted for 92 % of cases. Concomitant coronary heart disease (CHD) was diagnosed in 83 patients (75.3 %), and grade II–III stable angina was noted in 65% of the patients. Forty five (41 %) patients had a history of myocardial infarction. Type II diabetes mellitus was reported in 7 (6.3 %) patients. Previously, 26 (23.6 %) patients had myocardial revascularization. Four (3.6 %) patients had aortic valve stenosis.
In most cases – 91 (82.7 %) – the clinical course of the underlying disease was asymptomatic and oligosymptomatic.
The main indicators of EVAR long-term effectiveness are the absence of aneurysm rupture and aneurysmal sac reduction.
Statistical analysis showed stable and reliable relationship between the nature of morphological changes in the femoral artery wall and changes in the size of aneurysmal sac after EVAR. As for atherosclerotic changes, predominant aneurysmal sac reduction was observed in 77.7 % of cases, and only in 28.7 % of cases with dystrophic changes.
Patients undergoing EVAR require long-term regular follow-up using the methods like ultrasound and computerized tomography.
Monitoring of the changes in the aneurysmal sac size, detection of endoleaks and timely correction of the latter, if necessary, ensure long-term effectiveness of the intervention.
References
- Dingemans SA, Jonker FH, Moll FL, van Herwaarden JA. Aneurysm Sac Enlargement after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg. 2016 Feb;31:229–38.
- Antoniou GA, Georgiadis GS, Antoniou SA, Neequaye S, Brennan JA, Torella F, et al. Late Rupture of Abdominal Aortic Aneurysm After Previous Endovascular Repair: A Systematic Review and Meta-analysis. J Endovasc Ther. 2015 Oct; 22(5):734–44.
- Candell L, Tucker LY, Goodney P, Walker J, Okuhn S, Hill B, et al. Early and delayed rupture after endovascular abdominal aortic aneurysm repair in a 10-year multicenter registry. J Vasc Surg. 2014 Nov;60(5):1146–53.
- Zacharias N, Warner CJ, Taggert JB, Roddy SP, Kreienberg PB, Ozsvath KJ, et al. Anatomic characteristics of abdominal aortic aneurysms presenting with delayed rupture after endovascular aneurysm repair. J Vasc Surg. 2016 Dec;64(6):1629–32. https://doi.org/10.1016/j.jvs.2016.04.048. Epub 2016 Jul 16
- Zandvoort HJ, Gonзalves FB, Verhagen HJ, Werson DA, Moll FL, de Vries JP, et al. Results of endovascular repair of infrarenal aortic aneurysms using the Endurant stent graft. J Vasc Surg. 2014 May;59(5):1195–202. https://doi.org/10.1016/j.jvs.2013.12.031.
- Hwang D, Park S, Kim HK, Lee JM, Huh S. Reintervention Rate after Open Surgery and Endovascular Repair for Nonruptured Abdominal Aortic Aneurysms. Ann Vasc Surg. 2017 Aug;43:134–43. https://doi.org/10.1016/j.avsg.2017.03.168
- Nolz R, Teufelsbauer H, Asenbaum U, Beitzke D, Funovics M, Wibmer A, et al. Type II endoleaks after endovascular repair of abdominal aortic aneurysms: fate of the aneurysm sac and neck changes during long-term follow-up. J Endovasc Ther. 2012 Apr;19(2):193–9. https://doi.org/10.1583/11-3803.1
