Thorarinn Kristmundsson1, Jonathan Sobocinski2, Björn Sonesson1, Nuno Dias1, Stephan Haulon2, Timothy Resch1
1Vascular Center, Skåne University Hospital, Malmö, Sweden; 2Department of Vascular Surgery, Université Lille Nord de France, Hôpital Cardiologique, Lille, France.
OBJECTIVES: To evaluate operative results and short-term outcomes in early vs. late experience after fenestrated endovascular aortic repair (f-EVAR) in two tertiary European referral centers.
METHODS: All patients treated in (A) Malmö, Sweden, and in (B) Lille, France, with f-EVAR for abdominal aortic aneurysm (AAA) were prospectively enrolled in a computerized database. Early experience was defined as the first 50 patients treated at each center. Data from early and late experience was retrospectively analyzed and compared for differences in operative results and one-year outcomes.
RESULTS: Early experience covered 4.7 years in A and 4.5 years in B with late experience covering 5.6 years in A and 3.7 years in B. A total of 288 patients were included without significant differences in co-morbidities, gender (male 88%), age (72±7 years) and pre-operative AAA diameter (59±10 mm) between the groups. In the later phase, stent graft configuration was more complex due to increased number of fenestrations/scallops incorporated in the graft design (2.7±0.8 vs. 3.2±0.7, p<0.001). Despite this, contrast volume and radiation time decreased by 27% and 20%, respectively, while procedure time remained unchanged (279±123 minutes). At one year, AAA diameter decreased (≥5mm) in 54% of patients in the early group and in 62% of patients in the late group. Similar results for aneurysm expansion were 5% and 2%, respectively. No differences were found in operative mortality (2.1%), late mortality (3.8%), reintervention rate (10.5%), type I endoleaks (1.1%) or target vessel patency (98.4%) at one-year follow-up.
CONCLUSIONS: With increasing experience, f-EVAR design has become more complicated with more visceral vessels targeted for better proximal seal while operative risk still remains low. This has resulted in a larger portion of aneurysms decreasing in diameter during follow-up. Simultaneously, radiation time and contrast volume has been reduced with possible long-term benefits for the patient.
AUTHOR DISCLOSURES: N. Dias: Cook Medical, Consulting fees or other remuneration (payment); S. Haulon: Cook Medical, Consulting fees or other remuneration (payment); GE, Research grants; T. Kristmundsson: Nothing to disclose; T. Resch: Cook Medical, Consulting fees or other remuneration (payment); J. Sobocinski: Nothing to disclose; B. Sonesson: Nothing to disclose.
Posted April 2013