Endovascular repair for infra-renal aortic aneurysms with supra-renal fixation endoprosthesis: Results and outcomes

Abstract

Objective

The main objective of this paper is to evaluate the outcomes regarding endoleaks, reinterventions, and death related to aneurysm complications in patients submitted to endovascular repair (EVAR) for abdominal aortoiliac aneurysm (AAA) using Endurant II (Medtronic) and Zenith Flex (Cook) endografts.

Methods

This was a prospective, consecutive cohort study of patients with AAA who underwent EVAR with the use of Endurant II stent graft and Zenith Flex endograft.

Results

A total of 156 patients submitted to EVAR were evaluated. The perioperative mortality was 5.1%, 8 patients. The median clinical follow-up period was 760 ± 80 days. There were 28 patients (17.9%) submitted to urgent repair of the aneurysm (symptomatic expansion or rupture) and 128 patients (82.1%) submitted to elective repair. There were 36 cases (23.1%) of later endoleak and most of them are Type II endoleaks (21 patients, 13.4%). There were 12 cases of Type I endoleak. Moreover, regarding limb graft occlusion (LGO), there were 9 patients (5.8%). The overall survival rate in Kaplan–Meier analysis at 720 days was 84.8% in the total cohort. The freedom from reintervention rate in Kaplan–Meier analysis at 720 days was 92.7% in the total cohort. The linear regression analysis for survival rates showed that chronic kidney disease (p = .03; hazard ratio (HR) = 2.82, CI = 1.07–4.44) was the only factor related to poorer survival rates in both univariate and multivariate analyses. The linear regression analysis showed that the presence of endoleaks (p < .001, HR = 6.69, CI = 2.26–8.48) and limb graft occlusion (p < .001, HR = 8.02, CI = 1.60–9.99) were related to reintervention in both univariate and multivariate analyses.

Conclusion

In this present study, supra-renal fixation endograft devices were safe and efficient in treating AAA, with satisfactory results and no renal compromise. The linear regression analysis showed that the presence of endoleaks and limb graft occlusion were related to higher reintervention rates in both univariate and multivariate analyses.

Keywords

Aortoiliac aneurysm endografts supra-renal fixation endoleaks

Get full access to this article

View all access options for this article.

References

Greenhalgh

Brown

Kwong

, et al. EVAR trial participants, Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled. TrialLancet, 2004; 364: 843–848.

Lederle

Freischlag

Kyriakides

, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009; 302: 1535–1542.

Prinssen

Verhoeven

Buth

, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351: 1607–1618.

Miller

Razavi

Brajesh

. Suprarenal versus infrarenal stent graft fixation on renal complications after endovascular aneurysm repair. J Vasc Surg 2015; 61: 1340–1349.

Sun

Stevenson

. Transrenal fixation of aortic stent-grafts: short- to midterm effects on renal function—a systematic review. Radiology 2006; 240: 65–72.

Walsh

Boyle

Lynch

et al. Suprarenal endograft fixation and medium-term renal function: systematic review and meta-analysis. J Vasc Surg. 2008; 47: 1364-1370.

Georgiadis

Schoretsanitis

Argyriou

, et al. Long-term outcomes of the Endurant endograft in patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg 2023; 78(3): 668–678.

Teijink

JAW

Power

Böckler

. Editor’s choice—five year outcomes of the Endurant stent graft for endovascular abdominal aortic aneurysm repair in the ENGAGE registry. Eur J Vasc Endovasc Surg 2019; 58: 175–181.

Troisi

Torsello

Weiss

, et al. Midterm results of endovascular aneurysm repair using the Endurant stent-graft according to the instructions for use vs. off-label conditions. J Endovasc Ther 2014; 21: 841–847.

10.

Kawamata

Tajima

Ueda

, et al. Long-term outcomes of endovascular aortic aneurysm repair with the Zenith AAA endovascular graft: a single-center study. Jpn J Radiol 2020; 38(1): 77–84.

11.

Chaikof

Dalman

Eskandari

, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67(1): 2–77. DOI: 10.1016/j.jvs.2017.10.044.

12.

Bogdanovic

Stackelberg

Lindström

, et al. Limb graft occlusion following endovascular aneurysm repair for infrarenal abdominal aortic aneurysm with the Zenith Alpha, excluder, and endurant devices: a multicentre cohort study. Eur J Vasc Endovasc Surg 2021; 62(4): 532–539.

13.

Georgiadis

Schoretsanitis

Argyriou

, et al. Long-term outcomes of the Endurant endograft in patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg 2023; 78(3): 668–678.e14.

14.

Poublon

Holewijn

van Sterkenburg

SMM

, et al. Long-term outcome of the GORE EXCLUDER AAA endoprosthesis for treatment of infrarenal aortic aneurysms. J Vasc Intervent Radiol 2017; 28(Issue 5): 637–644.

15.

Lebas

Galley

Legall

, et al. Preservation of the internal iliac arteries with branched iliac stent grafts (Zenith bifurcated iliac side): 5 Years of experience. Ann Vasc Surg 2016; 33: 18–22.

16.

Mylonas

Ioannides

Ahmad

, et al. Comparison of two iliac branch devices and their midterm performance in maintaining blood flow to the internal iliac artery. J Endovasc Ther 2020; 27(5): 818–825.

17.

AbuRahma

Hass

AbuRahma

, et al. Management of immediate post-endovascular aortic aneurysm repair type Ia endoleaks and late outcomes. J Am Coll Surg 2017; 224(4): 740–748.

18.

Jones

Faris

Moore

. Mortality and risk factors for ruptured abdominal aortic aneurysm after repair endovascular (rARE). J Vasc Surg Cases Innov Tech 2023; 9(3): 101165.

19.

Patel

Sweeting

Powell

, et al. EVAR trial investigators, Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet 2016; 388(10058): 2366–2374.

20.

Väärämäki

Salenius

Pimenoff

, et al. Systematic long-term follow up after endovascular abdominal aortic aneurysm repair with the Zenith stent graft. Eur J Vasc Endovasc Surg 2019; 58(2): 182–188.

21.

Georgiadis

Schoretsanitis

Argyriou

, et al. Long-term outcomes of the Endurant endograft in patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg 2023; 78(3): 668–678.

22.

Sangtae

Wonsuk

Jinmo

, et al. Effect of stent graft fixation types on pararenal aortic diameter and renal function after endovascular aortic repair. Turk Gogus Kalp Damar Cerrahisi Derg 2021; 29: 434–442.

23.

Pintoux

Chaillou

Azema

, et al. Long-term influence of suprarenal or infrarenal fixation on proximal neck dilatation and stentgraft migration after EVAR. Ann Vasc Surg 2011; 25: 1012–1019.

24.

Sun

Stevenson

. Transrenal fixation of aortic stent-grafts: short- to midterm effects on renal function—a systematic review. Radiology 2006; 240: 65–72.

25.

Subedi

Lee

Landis

. Suprarenal fixation barbs can induce renal artery occlusion in endovascular aortic aneurysm repair. Ann Vasc Surg 2010; 24: 113.

26.

Sonesson

Malina

Ivancev

, et al. Dilatation of the infrarenal aneurysm neck after endovascular exclusion of abdominal aortic aneurysm. J Endovasc Surg 1998; 5: 195–200.

27.

Vallabhaneni

Harris

. Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair. Eur J Radiol 2001; 39: 34–41.

28.

Bogdanovic

Stackelberg

Lindström

29.

Ulsaker

Lam

Herje

, et al. A retrospective evaluation of intra-prosthetic Thrombus Formation after endovascular aortic repair in cook Zenith Alpha and medtronic endurant II patients. Eur J Vasc Endovasc Surg 2023; 66(5): 644–651.