The evolving technique of endovascular stenting of abdominal aortic aneurysm; Time for reappraisal

Purpose: to investigate the occurrence of intra-operative device-related co mplications during stent-grafting for abdominal aortic aneurysm. Materials and Methods: data on patient characteristics, vascular morphology , operative technical details, procedural and device-related complications were obtained from the European collaborators on stent-graft techniques for abdominal aortic aneurysm repair (EUROSTAR) registry. Only intra-operative device-related complications were taken into account. Potential risk facto rs for device-related complications were examined by logistic regression an alysis. The association between these complications and conversion to open surgery and death were determined. Results: between January 1994 and July 2000, 2862 patients in 90 participat ing hospitals underwent endovascular abdominal aortic aneurysm repair. Devi ce-related complications occurred in 238 (8.3%) patients. Complications wer e associated with the age of the patient (p = 0.002), gender (p = 0.05), sm oking habit (p = 0.001), pre-operative aneurysm diameter (p = 0.005), type of device implanted (p = 0.0001), fitness of the Patient for open surgery ( p = 0.002), and year of operation (p = 0.001). Adjusted for risk factors, t he occurrence of complications decreased between 1994 to 2000 from 21.7% to 7.3%, respectively, Patients with device-related complications were 13.6 t imes (95% CI, 9.2-20.1) more likely to have conversion to an open procedure and 2.4 times (95% CI, 1.4-4.0) more likely to die within 30 dalls of the operation. Conclusions: intra-operative device-related complications were common, alth ough appear to be decreasing infrequency, and were significantly related to conversion and post-operative death.