Does complete aneurysm exclusion ensure long-term success after endovascular repair?

Purpose: To examine whether complete aneurysm exclusion is a reliable marke r for successful long-term endovascular abdominal aortic aneurysm (AAA) rep air. Methods: The medical records, computed tomographic (CT) scans, and duplex e xaminations of all the patients who underwent endovascular AAA repair at a single institution and had at least 12 months of follow-up were reviewed. S ixty-seven patients (58 men; mean age 74 years, range 57-87) were identifie d. Complete aneurysm exclusion was defined by the absence of an endoleak at any time before an adverse event. The primary endpoint included all major adverse events that occurred during the postoperative period, including ane urysm expansion, acute symptoms referable to the AAA, late secondary proced ures, ruptures, and deaths from ruptures and all other causes. Results: There were 44 adverse events (8 expanding aneurysms, 4 acute sympt oms, 17 secondary procedures, and 15 deaths from other causes) in 28 (42%) patients. Among 36 (54%) patients who had initial complete aneurysm exclusi on (no endoleak), 12 (33%) experienced adverse events, compared with 16 (52 %) events in 31 patients who had endoleak (chi (2) = 1.59, p = 0.21). Conclusions: There was no statistically significant difference in adverse e vents based on the presence or absence of endoleak. Complete aneurysm exclu sion as defined by absence of an endoleak does not indicate an event-free p ostoperative course. A better marker of clinical success of endovascular AA A repair is needed.