Midterm durability of abdominal aortic aneurysm endograft repair: A word of caution

Purpose: Endograft technology for abdominal aortic aneurysm (AAA) repair is being applied more liberally. There is little information about the midter m performance of these grafts. This study is focused on follow-up intervent ions after endograft repair for AAA. Methods: Prospective follow-up analysis of a consecutive patient series (n = 173 patients) at a single center who underwent endovascular AAA repair up to 50 months after operation. Seventeen percent of the patients were regar ded unfit for open surgery. Four types of commercially available grafts wer e used. The Society for Vascular Surgery/International Society for Cardiova scular Surgery guidelines were applied for endograft implantation and data preparation. Results: In two patients, the procedure was converted to open surgery In on e procedure, emergency repair for iliac artery rupture was performed. The 3 0-day mortality rate was 2.8% (n = 5 patients). An early second procedure t o correct type I endoleaks was necessary in 8 cases (4.6%; 3-10 days). The following midterm results were obtained: median follow-up of the 166 remain ing patients was 18 months (range, 1-50 months); 50 additional procedures w ere necessary in 37 patients (22.3%) for the treatment of leaks (n = 45 int erventions) or to maintain graft patency (n = 5 grafts; four patients with concomitant graft segment disconnection); and 46% of the reinterventions we re performed within the first year of followup and 74% of the reinterventio ns were performed within the second year of follow-up. One patient died aft er emergency surgery for rupture as the result of a secondary endoleak at 1 year. Although seven interventions (14%) were performed for type II endole ak, no serious complications were related to patent sidebranches. There was no statistically significant difference between the need for maintenance i n different graft configurations (tubular, bifurcated, aorto-uniiliac), or number of graft segments (1, 2, 3-4, greater than or equal to5 segments). N ew generation grafts (after 1996) performed better than early generation gr afts (P = 0.04, chi-squared test) with regard to endoleak development. Conclusion: Endograft repair for AAA is safe but, with current technology, not as durable as open repair. Our data suggest that the use of endograft r epair for AAA is becoming safer as endograft design improves. Nevertheless in 26.6% of the patients, there is need for reintervention within midterm f ollow-up. Close follow-up is crucial because late leaks may develop after m ore than 2 years after the initial procedure. Endoluminal repair should the refore be applied with caution, strict indication, and only ifa tight follo w-up is warranted. These findings may also affect health care reimbursement policies.