Matched-Pair Analysis of Conventional versus Endoluminal AAA Treatment Outcomes during the Initial Phase of an Aortic Endografting Program

Abstract

Purpose:

To investigate whether endovascular stent-grafts implanted during the early phase of an aortic endografting program have advantages over conventional surgical procedures for treatment of infrarenal aortic aneurysm (AAA).

Methods:

In the first months of an endografting program, 37 patients (36 men; mean age 67.9 ± 7.1 years, range 55 to 86) underwent AAA repair with endovascular implantation of a Vanguard (n = 17) or Talent (n = 20) bifurcated stent-graft. Data collected during the perioperative period and in follow-up were compared retrospectively to a matched group of 37 elective surgical patients.

Results:

All endograft implantations were completed. Two type I and 6 type II endoleaks (21.6%) were seen postoperatively. Five type II sealed without intervention; 1 type I endoleak was corrected with an additional stent, but 1 type I and 1 type II endoleaks persisted despite attempts with coil embolization. Two (5.4%) endograft patients died during the perioperative period; however, this was not significantly different (p = 0.15) from the control group. In the mean follow-up of 12 ± 6 months for both groups, 1 (2.7%) late conversion was necessary at 2 years for aneurysm expansion in an endograft patient with an unsealed type I endoleak.

Conclusions:

In our learning curve experience with aortic endografting, postoperative morbidity and mortality were higher in endograft patients compared to conventionally treated controls. Only in the endograft group was reoperation required during follow-up. Careful monitoring with periodic imaging studies is mandatory after endoluminal AAA treatment.