Outcomes following endovascular reintervention for aortic interventions.

Abstract Objectives Endovascular reinterventions are often done following previous open or endovascular aortic procedures. We used the Global Registry for Endovascular Aortic Treatment (GREAT) to compare outcomes between these groups and compare reintervention of any type to the group of patients who underwent primary endovascular aortic repair. Methods All patients enrolled in GREAT were grouped according to history of previous abdominal endovascular procedure (PEP) or open abdominal aortic procedure (OAP). Univariate analysis was performed using Chi-square, Wilcoxon rank sum and Fisher’s Exact Tests. Cox proportional analysis was used to test predictors of all cause and aortic related mortality. Results There were 3,974 subjects with EVAR enrolled with follow-up. 196/3974 (4.9%) were reinterventions (49 following OAP (ROAP) and 147 following PEP (RPEP). RPEP tended to have a higher endoleak rate through two years (13.6% vs. 4.1%, p=0.07), although there was no difference in occurrence of intervention (12.2% vs. 17.7%, p=0.37). ROAP had higher all-cause mortality through two year follow-up (32.7% vs. 17.7%, p=.0.03) with predictors of mortality including prior intervention type (OAP), renal insufficiency and in those undergoing cut down for access. When compared with patients undergoing primary endovascular repair (PER), patients in the reintervention cohort were older (75.3 vs. 73.3, p=0.0005), only utilized femoral artery access (95.8% vs. 90.3%, p= p Conclusion Endovascular reintervention for aortic pathology is associated with higher mortality than primary EVAR. Reinterventions on prior open aortic procedures is associated with higher mortality than prior endovascular procedure.