IYSC12 - Predictors of Early and Late Failure after Contemporary Standard EVAR Procedures

Objectives: To report early/follow-up outcomes of standard endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs) with currently available endograft and identify predictors of technical/clinical failure

Methods: Patients undergoing EVAR between 2012 and 2020 were prospectively collected and retrospectively analyzed. Technical success (TS: no type I-III endoleaks, renal/hypogastric arteries loss, iliac leg occlusion, conversion to open repair and mortality within 24-postoperative hour), proximal neck-related TS (nr-TS: no proximal type I endoleaks, unplanned renal arteries coverage) and 30-day mortality were assessed as early outcomes. Proximal type I endoleak (ELIa), survival and freedom from re-interventions (FFRs) were assessed during follow-up. Risk factors for early and follow-up outcomes were analyzed

Results: Seven hundred and ten patients (male: 638-90%; mean age: 78+6 years; ASA>3: 686-96%) were included. The mean AAA diameter was 58+6 mm and 30 (4%) cases were treated in urgent setting. TS and nr-TS were 692(98%) and 700 (99%), respectively. The presence of > 2 hostile anatomical infrarenal neck characteristics was associated with technical failure (OR:2.4; 95%CI: 1.3-4.1; P:.007). Infrarenal neck angle >90° (OR:2.88; 95%CI:9.6-50.3; P:.004), barrel shape (OR:2.33; 95%CI:11.1-100.3; P:.02) or presence of > 2 hostile anatomical infrarenal neck characteristics (OR:2.16; 95%CI:2.5-5.3; P:.03) were independent risk factors for neck-related technical failures. Six (0.8%) patients died within 30 postoperative days. Chronic obstructive pulmonary disease (OR:16; 95%CI:1.1-218.3; P:.04) and urgent repair (OR:15; 95%CI:1.8-119.6; P:.01) were independent risk factors for 30-day mortality. The mean follow-up was 53+13 months. There were 12 (1.7%) ELIa during follow-up. Infrarenal neck length < 15mm (HR:2.8; 95%CI:1.9-9.6; P:.005), diameter >28mm (HR:2.7; 95%CI:1.6-9.5; P:.006), angle >90° (HR:2.7; 95%CI:8.3-50.1; P:.007) and persistent type II endoleak (HR:2.9; 95%CI:1.6-10.1; P:.004) were independent risk factors for ELIa. FFRs was 91% at 5-years. ELIa was an independent risk factor for reinterventions during follow-up (HR:29.5; 95%CI:1.4-1.6; P: <.001). Survival was 75% at 5-year with 2 cases (0.3%) of late aortic-related mortality. Peripheral arterial occlusive disease (HR:1.9; 95%CI:1.4-3.65; P:.03), aneurysm diameter >65mm (HR:2.2; 95%CI:1.4-3.26; P: <.001) and infrarenal neck length < 15mm (HR:1.7; 95%CI:1.2-2.35; P:.04) were independent risk factors for mortality during follow-up

Conclusions: EVAR with currently available endograft has a high TS and low 30-day mortality. Survival and FFRs were satisfactory at mid-term. Pre and postoperative risk factors for technical and clinical failure were identified and they should be considered in EVAR indication and post-operative management to reduce complications and improve mid-term outcome