Secondary interventions and long-term follow-up after Endovascular Abdominal Aortic Aneurysm Repair.

Abstract Objectives Early morbidity and mortality are low after endovascular abdominal aneurysm repair (EVAR), but secondary interventions and late complications are common. The aim of the present multicentre cohort study is to detail the frequency and indication for interventions after EVAR and the impact on long-term survival. Methods Retrospective multicentre cohort study of secondary interventions after elective EVAR for an infrarenal abdominal aortic aneurysm (AAA). Consecutive patients (n=349) undergoing EVAR between January 2007 and January 2012 were analysed, with long-term follow-up until December 2018. Those requiring intervention were classified according to the indications and specific nature of the intervention and treatment. The primary study endpoint was overall survival classified for patients with and without intervention. Kaplan-Meier analysis was used to estimate overall survival for those who did and who did not undergo secondary interventions. Univariable and multivariable Cox regression were performed to identify independent variables associated with mortality. Results Some 56 patients (16%) underwent 72 secondary interventions after EVAR during a median (IQR) follow-up period of 53.2 months (60.1). Some 45 patients (80.4%) underwent one intervention. Indications for intervention included mainly endograft kinking/outflow obstruction and type II endoleak. An endovascular technique was used in 40.3% of interventions. Median time to secondary intervention was 24.1 months. In 93 patients with abnormalities on imaging, no intervention was performed mainly because the abnormality had disappeared on follow-up imaging (43%). Kaplan-Meier curves showed no difference in survival for patients with and without secondary interventions (p = 0.153). Age (hazard ratio [HR] 1.089, 95% confidence interval [CI] 1.063-1.116), ASA classification (ASA III,IV HR 1.517, 95% CI 1.056-2.178) were significantly related to mortality. Conclusions Secondary interventions rates are still considerable after EVAR. Endograft kinking/outflow obstruction and endoleak type II are the most common indications for a secondary intervention. Secondary interventions did not adversely affect long-term overall survival after EVAR.