Risk of reintervention after endovascular aortic aneurysm repair

• Published in: British journal of surgery Vol. 97; no. 5; pp. 657 - 663
• Main Authors: Karthikesalingam, A., Holt, P. J. E., Hinchliffe, R. J., Nordon, I. M., Loftus, I. M., Thompson, M. M.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.05.2010; Wiley
• Subjects: Aged; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood Vessel Prosthesis; Female; General aspects; Humans; Intraoperative Care; Kaplan-Meier Estimate; Male; Medical sciences; Postoperative Care; Postoperative Complications - mortality; Postoperative Complications - surgery; Prospective Studies; Reoperation - mortality; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Stents; Tomography, X-Ray Computed; Ultrasonography, Doppler; Medicine; Treatment; Surgery; Risk factor; Cardiovascular disease; Risk; Endovascular route; Repair; Aortic aneurysm
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.6991

Background: The role of symptomatic presentation in directing reintervention after endovascular aortic aneurysm repair (EVAR) was investigated. Methods: All patients undergoing infrarenal EVAR between 2001 and 2009 were studied. Those needing reintervention were divided into symptomatic and asymptomatic presentations. Kaplan–Meier survival curves were used to calculate freedom from reintervention, and log rank tests for subgroup analyses. Multivariable analysis identified risk factors for reintervention. Results: The study included 553 patients with a mean(s.d.) age of 75(7) years and aneurysm diameter of 65(13) mm. The 30‐day mortality rate was 2·5 per cent. Median follow‐up was 31 (range 1–97) months. There were 86 reinterventions in 69 (12·5 per cent) of 553 patients; 41 presented with symptoms and 28 were asymptomatic. Reintervention‐free survival rates at 1, 3 and 5 years were 90·1, 85·3 and 81·2 per cent. The reintervention rate was higher in patients who needed an intraoperative adjunct during the index procedure (P = 0·014) and in those who did not have intraoperative computed tomography angiography (P = 0·024). Intraoperative adjuncts were an independent risk factor for future reintervention (hazard ratio 2·62, 95 per cent confidence interval 1·18 to 3·76; P = 0·012). Conclusion: Most patients requiring reintervention presented symptomatically. A high‐risk subgroup may be identifiable to rationalize a postoperative surveillance programme. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Asymptomatic presentation uncommon