TY - JOUR
T1 - Reintervention after EVAR and open surgical repair of AAA a 15-year experience
AU - Al-Jubouri, Mustafa
AU - Comerota, Anthony J.
AU - Thakur, Subhash
AU - Aziz, Faisal
AU - Wanjiku, Steven
AU - Paolini, David
AU - Pigott, John P.
AU - Lurie, Fedor
PY - 2013/10/1
Y1 - 2013/10/1
N2 - Objective: This study examined the frequency and reason for reinterventions and their impact on survival in contemporaneously treated cohorts of EVAR and open surgical repair (OSR) patients. Background: EVAR has largely replaced OSR for anatomically appropriate AAAbecause of improved short-termoutcomes. However,EVARis associated with a notable reintervention rate. Methods: Data for patients undergoing elective AAA repair between 1996 and 2011 were collected and analyzed to assess time from initial procedure to reintervention and rate of reintervention. Patient demographics, comorbidities, number and type of reinterventions, graft type, and timing of reintervention were analyzed. Results: A total of 1144 patients underwent AAA repair; 558 had EVAR and 586 had OSR. In 76 EVAR patients, 123 reinterventions were performed; 46 reinterventions were performed in 30 OSR patients (P < 0.0001). Endoleak was responsible for 66% of EVAR reinterventions; colonic ischemia, bleeding, and incisional hernias caused 30%, 22%, and 22% of OSR reinterventions, respectively. Time to first reintervention was shorter in OSR patients (P < 0.001) and was related to AAA size (P < 0.001). Early reintervention at the index procedure in OSR patients had a 23% mortality rate. If reinterventions were not required, survival curves were similar. Current endografts require fewer reinterventions than earlier generation endografts. Conclusions: Reintervention was more common with EVAR and occurred later. Early reintervention after OSR is associated with significant mortality. If early reintervention in OSR patients can be avoided, there is no early survival advantage to EVAR. Current endografts require fewer reinterventions than earlier devices.
AB - Objective: This study examined the frequency and reason for reinterventions and their impact on survival in contemporaneously treated cohorts of EVAR and open surgical repair (OSR) patients. Background: EVAR has largely replaced OSR for anatomically appropriate AAAbecause of improved short-termoutcomes. However,EVARis associated with a notable reintervention rate. Methods: Data for patients undergoing elective AAA repair between 1996 and 2011 were collected and analyzed to assess time from initial procedure to reintervention and rate of reintervention. Patient demographics, comorbidities, number and type of reinterventions, graft type, and timing of reintervention were analyzed. Results: A total of 1144 patients underwent AAA repair; 558 had EVAR and 586 had OSR. In 76 EVAR patients, 123 reinterventions were performed; 46 reinterventions were performed in 30 OSR patients (P < 0.0001). Endoleak was responsible for 66% of EVAR reinterventions; colonic ischemia, bleeding, and incisional hernias caused 30%, 22%, and 22% of OSR reinterventions, respectively. Time to first reintervention was shorter in OSR patients (P < 0.001) and was related to AAA size (P < 0.001). Early reintervention at the index procedure in OSR patients had a 23% mortality rate. If reinterventions were not required, survival curves were similar. Current endografts require fewer reinterventions than earlier generation endografts. Conclusions: Reintervention was more common with EVAR and occurred later. Early reintervention after OSR is associated with significant mortality. If early reintervention in OSR patients can be avoided, there is no early survival advantage to EVAR. Current endografts require fewer reinterventions than earlier devices.
UR - http://www.scopus.com/inward/record.url?scp=84884500400&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84884500400&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000000157
DO - 10.1097/SLA.0000000000000157
M3 - Article
C2 - 24002301
SN - 0003-4932
VL - 258
SP - 652
EP - 657
JO - Annals of Surgery
JF - Annals of Surgery
IS - 4
ER -