Comparison of Treatment Outcomes between Graft Replacement and Aneurysmorrhaphy with Graft Preservation for Type 2 Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair
{"title":"Comparison of Treatment Outcomes between Graft Replacement and Aneurysmorrhaphy with Graft Preservation for Type 2 Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair","authors":"Koichi Morisaki , Shinichiro Yoshino , Daisuke Matsuda , Shun Kurose , Jun Okadome , Ken Nakayama , Ryosuke Yoshiga , Kentaro Inoue , Tadashi Furuyama , Terutoshi Yamaoka , Masazumi Kume , Takuya Matsumoto , Jin Okazaki , Hiroyuki Ito , Toshihiro Onohara , Tomoharu Yoshizumi","doi":"10.1016/j.avsg.2025.01.015","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to compare treatment outcomes between graft replacement and aneurysmorrhaphy with ligation of the aortic side branches for type 2 endoleaks after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed multicenter data of patients who underwent open surgical conversion, including graft replacement or aneurysmorrhaphy with ligation of the aortic side branches (graft preservation) for the treatment of type 2 endoleaks between 2007 and 2022. The endpoints were postoperative complications, 30-day mortality, overall survival, and reintervention or sac expansion after open surgical conversion.</div></div><div><h3>Results</h3><div>Forty patients underwent open surgical conversion (graft replacement, <em>n</em> = 9; graft preservation, <em>n</em> = 31). There were no significant differences in patient characteristics at open surgical conversion or anatomical data of the initial EVAR between the groups. The median operative time and amount of blood loss were significantly lesser in the graft preservation group than in the replacement group (179 vs. 318 min, <em>P</em> < 0.001, and 710 vs. 2,567 mL, <em>P</em> = 0.030, respectively). There was no difference in the occurrence of postoperative complications between the 2 groups (<em>P</em> = 0.645). No 30-day mortality was observed in any of the groups. Overall survival rate at 5 years after open surgical conversion was 85.7% in the graft replacement group and 77.8% in the graft preservation group (<em>P</em> = 0.789). Freedom from sac expansion or reintervention rate at 5 years after open surgical conversion was 100% in the graft replacement group and 76.0% in the graft preservation group (<em>P</em> = 0.239).</div></div><div><h3>Conclusion</h3><div>Aneurysmorrhaphy with ligation of the aortic side branches was less invasive treatment compared with graft replacement, although there were no differences in postoperative complications. No reintervention was needed after graft replacement; however, some patients required reintervention after graft preservation. Further studies are needed to determine the optimal surgical procedure for the treatment of type 2 endoleak.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"113 ","pages":"Pages 186-194"},"PeriodicalIF":1.4000,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0890509625000421","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Background
This study aimed to compare treatment outcomes between graft replacement and aneurysmorrhaphy with ligation of the aortic side branches for type 2 endoleaks after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms.
Methods
We retrospectively analyzed multicenter data of patients who underwent open surgical conversion, including graft replacement or aneurysmorrhaphy with ligation of the aortic side branches (graft preservation) for the treatment of type 2 endoleaks between 2007 and 2022. The endpoints were postoperative complications, 30-day mortality, overall survival, and reintervention or sac expansion after open surgical conversion.
Results
Forty patients underwent open surgical conversion (graft replacement, n = 9; graft preservation, n = 31). There were no significant differences in patient characteristics at open surgical conversion or anatomical data of the initial EVAR between the groups. The median operative time and amount of blood loss were significantly lesser in the graft preservation group than in the replacement group (179 vs. 318 min, P < 0.001, and 710 vs. 2,567 mL, P = 0.030, respectively). There was no difference in the occurrence of postoperative complications between the 2 groups (P = 0.645). No 30-day mortality was observed in any of the groups. Overall survival rate at 5 years after open surgical conversion was 85.7% in the graft replacement group and 77.8% in the graft preservation group (P = 0.789). Freedom from sac expansion or reintervention rate at 5 years after open surgical conversion was 100% in the graft replacement group and 76.0% in the graft preservation group (P = 0.239).
Conclusion
Aneurysmorrhaphy with ligation of the aortic side branches was less invasive treatment compared with graft replacement, although there were no differences in postoperative complications. No reintervention was needed after graft replacement; however, some patients required reintervention after graft preservation. Further studies are needed to determine the optimal surgical procedure for the treatment of type 2 endoleak.
期刊介绍:
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence