Secondary intervention after endovascular XXXX repair.

@entity1 @entity1070 @entity7244 @entity439 @entity1028
OBJECTIVE: Endovascular @entity1028 Repair (EVAR) has been criticized because of the need for frequent secondary interventions (2ndINT) to maintain effective @entity1028 ( @entity1028 ) exclusion. The study goal is to detail such interventions and determine their effect on clinical outcomes. METHODS: From January 1997 to December 2007, 832 @entity1 underwent EVAR. Those requiring 2ndINT were stratified according to the indications and specific nature of 2ndINT and treatment. Study endpoints included freedom from 2ndINT, @entity439 -related and overall survival. RESULTS: There were 91 (11%) @entity1 who underwent 131 2ndINT (mean follow-up 35 months). No demographic features (age, gender, etc) predicted the need for 2ndINT. Actuarial 5-year freedom from 2ndINT was 80%. Indications for 2ndINT included: sac rupture 5 (4%), graft migration/ type I endoleak 37 (28%), persistent @entity1070 (38%), endotension with sac growth 5 (4%), and limb occlusion/kinking 24 (18%). The majority of 2ndINT were accomplished with an endovascular approach (76%) with a >80% initial success rate for all indications except @entity1070 in which the initial intervention was successful only 34% of the time. Initial 2ndINT were successful in 62% and 35 (38%) @entity1 underwent more than one 2ndINT. Multivariate predictors of 2ndINT were @entity1028 sac size >5.5cm (OR = 2.1, P = 0.004), and preprocedure coil embolization ( @entity7244 ) (OR = 2.1, P = 0.008). The actuarial survival was 70% at 5 years and the @entity439 -related survival was 97.5% with no difference in either parameter in @entity1 who underwent 2ndINT compared with those who did not. CONCLUSIONS: Although 2ndINT are common after EVAR, most were addressed through an endovascular approach; technical success thereof varies widely with the specific indication for 2ndINT. Secondary intervention did not adversely affect @entity439 -related or overall actuarial 5-year survival.
