Secondary procedures after endovascular aortic aneurysm repair

Abstract

Purpose: The purpose of this study was to evaluate the incidence, distribution, and indications of secondary procedures after endovascular aortic aneurysm repair (EAR). Methods: At a single institution, 179 patients underwent EAR with four different endografts (AneuRx, n = 117; Zenith, n = 49; Ancure, n = 12; and Talent, n = 1). The vascular section database was queried for patients who needed secondary procedures after the original EAR. The mean time from EAR to the termination of the study was 27.0 ± 16.7 months. Type I or III endoleaks were treated aggressively. Type II endoleaks were treated only in the presence of aneurysm expansion. Results: Thirty-five (35/179; 19.6%) secondary procedures were performed in 32 patients. Indications for secondary procedures included 14 limb occlusions or stenoses (40.0%), 13 endoleaks (37.1%), six endograft migrations (17.1%), one delayed aneurysm rupture (2.8%), and one device malfunction (2.8%). Seven of the 10 early (<90 days) limb failures (70%) occurred within the first 60 patients. At that time, a protocol with aggressive external iliac artery evaluation was adopted. In the next 125 patients, the rate of early limb occlusion or stenosis was 2.4% (P = .025, with Fisher exact test). Distribution of secondary procedures included 23 endoluminal interventions (65.7%; angioplasty ± stent placement, thrombolysis, endocuff placement, embolization), eight traditional peripheral procedures (22.9%; femoral-femoral bypass, thrombectomy), two laparoscopic interventions (5.7%; inferior mesenteric artery ligation), and two laparotomies (5.7%; delayed conversions). Interventions for limb occlusion or stenosis occurred earliest (3.5 ± 5.4 months; P < .05, with analysis of variance), followed by treatment of endoleaks (14.3 ± 12.9 months) and migration (27.5 ± 10.4 months). The one delayed rupture occurred at 15.3 months. Conclusion: Secondary procedures after EAR are common. Reinterventions can be grouped temporally on the basis of indication. Treatment for limb ischemia is predominately early (≥3 months), whereas treatment for endoleaks occurs at approximately 1 year and interventions for migration predominate after 2 years.