Ying Huang, Peter Gloviczki, Audra A. Duncan, Gustavo S. Oderich, Manju Kalra, Mark D. Fleming, Thomas C. Bower
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
OBJECTIVES: To analyze factors affecting outcome after EVPAR.
METHODS: Clinical data of consecutive PAA patients treated with EVPAR (2000-2012) were reviewed. Primary endpoints were major adverse events: mortality, thrombosis, amputation, complications, reinterventions.
RESULTS: EVPAR was performed in 46 limbs, 38 patients: elective: 33 (72%), emergent: 13 (28%). One aneurysm ruptured, 12 caused acute ischemia (12 underwent thrombolysis+ EVPAR). Mean of 2 Viabahn® stent-grafts (range 1-4) were used. Sixteen procedures (35%) were performed percutaneously, 30 through femoral cutdown. Technical success was 98%. Thirty-day mortality was 4.4%, all after emergencies (15.4%, 2/13). Thirty-day primary and secondary patencies were 100% for elective, 75% and 84%, respectively, for emergencies. Two major amputations (15.4%) were done after emergent EVPAR. Early complications were more frequent after emergencies (77% vs. 12%, p< 0.0001). Intracranial hemorrhage occurred in one patient (2.2%). Mean follow-up was 2.2 years (30 days-8.6 years). At 2 years, primary patencies were 70% and 64% (p=0.44), secondary patencies 80% and 84%, (p=0.79); no limb was lost in elective cases, limb salvage was 84% for emergencies (p=0.02); reinterventions were similar (19% and 30%); major adverse events occurred after 20 procedures (44%) (elective: 38%, emergent: 64%, p=0.01). There were 5 conversions (elective: 4, emergent: 1). Factors affecting adverse events included emergent EVPAR and percutaneous placement.
CONCLUSIONS: PAA with acute presentation continues to have elevated mortality (16%) and limb loss (16%). Although elective EVPAR has excellent early results, 2-year patency of 80% remains a concern.
AUTHOR DISCLOSURES: T. C. Bower: Nothing to disclose; A. A. Duncan: Nothing to disclose; M. D. Fleming: Nothing to disclose; P. Gloviczki: Nothing to disclose; Y. Huang: Nothing to disclose; M. Kalra: Nothing to disclose; G. S. Oderich: Gore, Consulting fees or other remuneration (payment); Cook, Consulting fees or other remuneration (payment).
Posted April 2013