Contemporary Incidence of Remedial Procedures after EVAR

Background: The need for remedial procedures after EVAR has historically been reported to be 10% per annum. This study was designed to define the contemporary incidence of remedial procedures after EVAR for intact AAAs from a mature endovascular practice.
Methods: A retrospective review of all pts undergoing EVAR since the inception of our program was performed (1997 - 2007). Data were prospectively collected in an EVAR registry. Postoperative CT scans were obtained at 1 mos, 6 mos, 12 mos, and yearly thereafter. Remedial procedures were performed for ruptured aneurysms, aneurysm enlargement (i.e. > 5 mm), type I/III endoleaks, symptomatic limb occlusion, device migration/fixation, and structural failures.
Results: 572 patients (male - 89%, age - 74 + 85 yrs (mean + SD), diameter - 59 + 11 mm) underwent EVAR. Perioperative outcome: mortality - 1.6%, morbidity - 29%, technical success - 99%, open conversion - 0.5%, adjunct procedures - 26%. EVAR devices used: Cook Zenith - 260 (45%), Medtronic AneuRx - 171 (30%), Gore Excluder - 115 (20%), other - 26 (5%). The mean followup was 25.4 mos. Postoperative survival was 91 + 1 (mean + SE), 79 + 3, and 71 + 6 at 1 yr, 3 yrs, and 5 yrs respectively by life table. 81 pts required 122 remedial procedures including proximal graft extension - 22, open surgical bypass for iliac limb occlusion - 17, access vessel repair -15, distal graft extension - 13, open conversion - 7. Freedom from remedial procedures was 91 + 1, 79 + 3, and 71 + 6 at 1 yr, 3 yrs, and 5 yrs. The freedom from remedial procedures for three most commonly used devices was comparable.
Conclusions: The contemporary need for remedial procedures remains significant despite the technical advances associated with the devices and our clinical expertise. Aggressive, long-term surveillance remains mandatory.