Correção endovascular de aneurismas da aorta abdominal em doentes com anatomia desfavorável: resultados institucionais a curto e médio prazo

Abstract

Background

The goal of this study is to determine the influence of abdominal aortic aneurysm (AAA) anatomy in endovascular aneurysm repair (EVAR) short and mid‐term outcomes.

Methods

A total of 112 patients underwent programed aorto‐biiliac EVAR at a single center between January 2011 and December 2013. Pre and postoperative imaging follow‐up were retrospectively reviewed and anatomical measures were calculated on Osirix® with center lumen line. Only patients with a postoperative imaging follow‐up of more than 12 months were included, resulting in the exclusion of thirty three (29%) cases. Patients were divided into 2 groups: the “EVAR suitable anatomy” group (f‐IFU) and the “EVAR challenging anatomy” group (df‐IFU).

Results

A total of 35.5% (n = 28) patients were in the df‐IFU group. These patients had larger AAA diameter (64.4 ± 10.1 mm vs 60.6 ± 10.8 mm) and shorter proximal neck (19.8 ± 11.8 mm vs 30.4 ± 14.4 mm) (p < 0.05).

The device preferentially used was Endurant® (54,5%). The df‐IFU group was more likely to be treated with suprarenal fixation devices (85.7% df‐IFU vs 69% f‐IFU, p = .048).

Mean follow‐up was 21,9 ± 9,8 months (12‐46).

Perioperative mortality (0% df‐IFU vs 2% f‐IFU) and all‐cause mortality rates (12% df‐IFU vs 11,9% f‐IFU) were similar between the two groups (p > 0.05). There was no significant difference in endoleak rate (short‐term 25% df‐IFU vs 22% f‐IFU; mid‐term 12% df‐IFU vs 23.8% f‐IFU) and in re‐intervention rates (short‐term 7.2% df‐IFU vs 8% f‐IFU; mid‐term 4% df‐IFU vs 4.8% f‐IFU)(p > 0.05).

Conclusion

Endovascular treatment of AAA patients with challenging anatomy for EVAR provided acceptable short and mid‐term results that are comparable to those in patients with suitable anatomy. Long‐term follow‐up is unreliable necessary to confirm these results.