Life-table analysis of primary and assisted success following endoluminal repair of abdominal aortic aneurysms: the role of supplementary endovascular intervention in improving outcome

Aim: the aim of this study was to analyse the effect of supplementary endov ascular intervention on the outcome of primary endoluminal repairs of abdom inal aortic aneurysm (AAA). Methods: between May 1992 and December 1998, 266 patients underwent endolum inal repair of AAA. Minimum period of follow-up was 6 months. Those patient s in whom the endoprosthesis could not be deployed were converted to open r epair at the primary operation. Patients developing an early endoleak, with in 31 days, were treated by a period of observation and secondary endovascu lar intervention in persistent cases. Patients developing a late endoleak w ere treated similarly, without a period of observation. Outcome was analyse d by the life-table method. Primary success occurred when aneurysms with en doleaks became excluded from the circulation as a result of supplementary e ndovascular intervention. Results: endoluminal repair failed in 17 patients requiring conversion to o pen repair at the original operation Supplementary endovascular interventio n was undertaken in 26 patients, with early endoleaks (n = 6) and late endo leaks (n = 20). Interventions involved deployment of secondary endoluminal grafts within the primary grafts (n = 22), and coil embolisation (n = 4). S uccessful exclusion of the aneurysm sac was achieved in 22 of 26 (85%) pati ents undergoing supplementary endovascular procedures, Conditional cumulati ve incidence od primary graft failure and secondary graft failure in the pr esence of all-cause mortality at 6 years was 47% and 25% respectively. Conclusions: supplementary endovascular intervention is an important adjunc t to endoluminal AAA repair with the potential to improve outcome and avoid conversion to open repair. Successful supplementary endovascular intervent ion was achieved in 85% of patients in whom it was attempted. Life-table an alysis showed these supplementary procedures to be durable in the long term .