Endovascular aneurysm repair: experience of 12 years in a single institution

Objective: In the last 10 years endovascular repair has proved to be an alternative to open surgery for the treatment of abdominal aortic aneurysms. Early and mid-term results for EVAR are known throughout the literature, otherwise long-term results have been published recently. We report our experience in the last 12 years evaluating early and long-term results of applying this technique. Methods: From January 1998 to June 2010, 494 of 1237 patients (39.9%) underwent EVAR in our centre for an abdominal aortic aneurysm. Most EVARs were performed on males (92.9%). Patients’ median age was 73 years (range 49–91 years). All procedures were performed by experienced Vascular Surgeons in Operatory Room with anesthesiological assistance. After the procedure, patients were routinely followed-up at two months with a duplex ultrasound, at six months with a contrast-enhanced CT-scan, then at 12 months and every year with a duplex ultrasound. Median follow-up was 68 months (range 1–144 months). Data were collected about perioperative and long-term cardiac and renal complications, thrombosis, surgical conversions, endoleaks, death and death from aortic rupture. All data were analysed using Sigma Stat 3.0. Results: The procedure was successfully ended in 488 patients (98.8%). Immediate surgical conversion was necessary in six patients (1.2%) for acute thrombosis of the graft (one patient), rupture of iliac artery (2), incomplete opening of the graft (3). At 30 days we observed six deaths (1.2%), 12 acute renal failures (2.4%), three graft thrombosis (0.6%) and six (1.2%) myocardial infarction (MI). Long-term results were collected on 391 patients (81.1%). We observed five MI (1.2%), 10 chronic renal failures (2.5%), eight graft thrombosis (2.0%), 77 deaths (19.7%), 31 type I endoleaks (7.9%), 12 type II endoleaks (3.0%), three type III endoleaks (0.7%). There were not any type IV, V nor VI endoleaks. Reintervention was necessary in 45 patients (11.5%); eight of them (2.0%) were late surgical conversion, all within 60 months from the first intervention. Aortic rupture occurred in five patients (1.2%), three of them were fatal. At 144 months 32.8%+4.4% of patients were alive and free from any major adverse events, 5.2%+5.6% of patients were alive, 97.5%+1.1% were free from aortic rupture and 65.4%+5.4% were free from graft-related complications. Conclusions: In our experience EVAR was safe and effective both at early and at long-term results, especially in relation to the prevention of late aortic rupture and aneurysm-related mortality, which are the main outcomes of endovascular treatment.