Rupture After Endovascular Abdominal Aortic Aneurysm Repair: A Multicenter Study

Vascular and Endovascular Surgery 1-6 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1538574414561225 ves.sagepub.com

Constantine N. Antonopoulos, MD1, John D. Kakisis, MD1, Triantafillos G. Giannakopoulos, MD1, Vasilios Andrikopoulos, MD2, Pavlos Antoniadis, MD3, Nikolaos Bessias, MD2, Konstantinos Dervisis, MD3, Sotirios Georgopoulos, MD4, Athanasios Giannoukas, MD5, Elias Kaperonis, MD6, Dimitrios Kiskinis, MD7, Christos Klonaris, MD4, Anastasios Machairas, MD8, Vasilios Papavassiliou, MD6, Vasilios Saleptsis, MD5, Nikolaos Saratzis, MD7, Konstantinos Seretis, MD8, Charalambos Tampakis, MD3, and Christos D. Liapis, MD1

Abstract A total of 22 patients with ruptured abdominal aortic aneurysms (rAAAs) after previous endovascular aortic repair (EVAR; rAAAevar) were presented to 7 referral hospitals in Greece, between January 2006 and April 2012. Type Ia endoleak and endograft migration were identified in 72.7% and 50%, respectively. Compliance to follow-up protocol prior to rupture was 31.8%. In-hospital mortality was 36.4% (9.1% for those treated with secondary EVAR and 63.6% for those treated with open surgical repair, P ¼ .02). An increase in the proportion of patients with rAAAevar among the total number of patients with rAAAs from 1.3% in 2007 to 18.2% in 2012 (P for trend ¼ .04) was recorded, corresponding to an annual increase of 2.8% (b ¼ 2.84, P ¼ .04). Rupture after EVAR seemed to be a clinical entity encountered with increasing frequency over the past years. Type I endoleak and endograft migration were most frequently observed, whereas compliance to follow-up was low. Keywords abdominal aortic aneurysm, rupture, mortality, endovascular aortic repair, EVAR

Introduction Endovascular aortic repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA) has been increasingly used during the last decade, mainly due to enhanced screening protocols, improvements in diagnostic modalities, cumulative experience gained in endovascular techniques, and patient’s preference.1 However, 10% to 30% of patients with AAA who are treated with EVAR may require secondary interventions due to endoleak, stent graft migration, stent fracture, aortic neck dilatation, and aneurysm sac expansion, and, as a result, the long-term durability of EVAR still remains a concern.2 A recent metaanalysis of 52 220 cases with aneurysm comparing 30-day and long-term mortality, reintervention, rupture, and morbidity after EVAR and open surgical repair (OSR) for AAA concluded that a significantly higher proportion of patients undergoing EVAR required reintervention (P ¼ .003) and had aneurysm rupture (P < .001), compared to patients undergoing

1 Department of Vascular Surgery, University General Hospital ‘‘Attikon’’, Athens, Greece 2 Department of Vascular Surgery, General Hospital ‘‘Korgialenio—Benakio National Red Cross’’, Athens, Greece 3 Department of Vascular Surgery, General Hospital ‘‘Konstantopoulio—Agia Olga’’, Athens, Greece 4 Department of Vascular Surgery, General Hospital ‘‘Laikon’’, Athens, Greece 5 Department of Vascular Surgery, University Hospital of Larissa, Larissa, Greece 6 Department of Vascular Surgery, General Hospital ‘‘Sismanoglio’’, Athens, Greece 7 Department of Vascular Surgery, General Hospital of Thessaloniki ‘‘Papageorgiou’’, Thessaloniki, Greece 8 3rd Surgical Department, University General Hospital ‘‘Attikon’’, Athens, Greece

Corresponding Author: Constantine N. Antonopoulos, Department of Vascular Surgery, University General Hospital ‘‘Attikon’’, 1 Rimini Street, 124 62, Haidari, Athens, Greece. Email: [email protected]

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Vascular and Endovascular Surgery

OSR.3 Furthermore, sporadic cases of ruptured AAAs (rAAAs) after previous EVAR (rAAAevar) have also been reported in the literature.4 Scrutinization of these cases may offer valuable information in the era of stent graft technology and enrich vascular interventionalists’ experience. The aim of this multicenter study was to present a comprehensive retrospective review of a prospectively maintained database of patients who presented with ruptured AAAs (rAAAs) after EVAR (rAAAevar) during a 6-year period in Greece, trying to explore time trends and reasons of rupture and mortality.

Methods Patients Records of all consecutive patients presenting with infrarenal rAAAevar repair between January 2006 and April 2012 were reviewed. Participating hospitals included 5 tertiary referral hospitals in Athens (University General Hospital ‘‘Attikon,’’ General Hospital ‘‘Korgialenio—Benakio National Red Cross,’’ General Hospital ‘‘Konstantopoulio—Agia Olga,’’ General Hospital ‘‘Laikon,’’ and General Hospital ‘‘Sismanoglio’’) and 2 hospitals in major cities of Greece (‘‘University Hospital of Larissa’’ and General Hospital of Thessaloniki ‘‘Papageorgiou’’).

Management Strategy All admitted patients were resuscitated with intravenous fluids to the point of hypotensive hemostasis. Hemodynamic instability was defined as systolic blood pressure 32 mm, neck length 60 , diameter of iliac vessels

Rupture after endovascular abdominal aortic aneurysm repair: a multicenter study.

A total of 22 patients with ruptured abdominal aortic aneurysms (rAAAs) after previous endovascular aortic repair (EVAR; rAAAevar) were presented to 7...
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