The impact of stent-graft development on outcome of AAA repair - a 7-year experience

Objective: to analyse the impact of stent-graft (SG) design and operator sk ill on the outcome of endovascular AAA repair. Design: prospective non-randomised open. Material: a total of 158 patients (mean age 71) underwent SG repair. Patien ts were treated with five different types of SG: first (n = 58) and second (n = 17) generation Ivancev-Malmo monoiliac SG (IM I and IM II respectively ) combined with femoral-femoral crossover, Chuter bifurcated SG (n = 15), V anguard Sg (n = 15) and the Zenith SG (n = 53). Methods: patients underwent DSA and contrast CT preoperatively and were the n followed with CT and digital scans. Recently, one change in AAA diameter and endoleaks (EL) were recorded. Mortality, complications and secondary in terventions were recorded and life-table analysis for intervention-free SG survival calculated. Results: immediate and late conversions as well as 30-day mortality were re duced for 2nd (Zenith and Vanguard) compared to 1st generation SG (IM I, Im II and Chuter). SG migrations occurred only with the IM I and Chuter SG. T ype I EL were significantly more common in 1st generation SG. First generat ion SG required significantly more secondary interventions than 2nd SG up t o 20 months post-operatively. The number of unplanned intraoperative adjunc tive manoeuvres was increased with 2nd SG. Conclusions: enhanced SG design has improved the probability of SG success after endovascular AAA repair. Better technical skills may also have contri buted to improved results.