Long-term Follow-up of 83 Patients after Endovascular Stent Graft (EVSG) Repair of Abdominal Aortic Aneurysms (AAA): A Single Center's Experience

Objective: Information on long-term follow-up after EVSG is limited. We review five-year outcomes of EVSG repairs performed at a high-volume aortic center.
Methods: From January 1, 1997 to January 1, 2006, 1048 patients underwent EVSG repair of AAA at Mount Sinai Medical Center. Patients with 5-year follow-up were reviewed for demographics, aneurysm size before and after repair, device design and re-interventions. Statistical significance was determined by Student's t-test
Results: Eighty-three patients had a 5 year minimum follow-up. Mean age at the time of repair was 72.3 years, and mean aneurysm diameter was 58 mm. Fifty-five patients had bifurcated devices, 13 had aorto-uni-iliac devices and 15 had tube grafts. Primary success was achieved in 71 patients (86%). Twenty-one patients (25%) required re-interventions at an average of 2.9 years after device implantation. Twelve patients had re-intervention for Type I endoleaks, which were signficantly correlated with tube grafts (p<0.001) Re-interventions were also performed for Type II endoleaks with aneurysm expansion (5), and for limb occlusion (4). All Type I endoleaks and Type II endoleaks were treated by endovascular means. Limb occlusions were treated with extra-anatomic bypass. Patients who did not require re-intervention had significantly greater aneurysm shrinkage, compared with those who did (-8.3 mm vs. 2.3 mm, p<0.01).
Conclusion: EVSG repair of AAA offers freedom from re-intervention in most patients. Failures were associated with earlier devices, and can often be repaired without laparotomy. The use of tube grafts in primary endovascular AAA repair should be discouraged except in very specialized anatomic circumstances.