5 Year Results of EVAR Used According to Instructions for Use Gives a Good General Outcome for AAA

Introduction: When EVAR has been used with low compliance to instructions for use (IFU), considerable percentages of the patients have faced AAA sac enlargement and complications. In our institution EVAR has been used according to IFU. We wanted to explore the results after 5 years for EVAR and the disease in general with this approach. Methods: 123 patients were intended to be treated electively with EVAR 2002–2007 using Cook Zenith stent grafts. Mean aneurysm diameter at operation was 62.7 mm (40 mm–105 mm. Indications for EVAR were as follows, aortic neck: length 15 mm or more, diameter 32 mm or less, straight configuration (cone shaped neck only with distal narrowing); iliac arteries: length >10 mm, 7.5–20 mm in diameter. In the same period 139 patients were treated by open repair. Results: At five years, 7.3% (CI 2.7–11.9%) of the elective intended to treat patients with EVAR had an increase in aneurysm diameter. 38.2 % of patients were registered with endoleaks during the follow up period but only 5.7 % had secondary procedures.13 % of patients had secondary procedures for other reasons 12.2 % of patients had early and 6.5 % late complications during the follow up period. Aneurysm rupture was seen in 1.6 % of patients. During the 5 years of follow up there was no statistical difference in standardized mortality ratio in patients treated with elective EVAR compared to the general population. The 1 year mortality of those electively treated with open AAA repair and EVAR was 7.6%, and 6.3 % respectively. There was no statistically significant difference seen in 1 year mortality between elective open operation and elective EVAR. Conclusion: Adhering to proven indications for use of EVAR gives a low long-term risk for increased diameter, low mortality rate and low rate of secondary procedures in treated aortic aneurysms compared to other published results. With this approach no statistical difference in standardized mortality was seen in patients treated with EVAR compared to the general population. This is the case even if the risk for AAA rupture after treatment will still not be entirely excluded with EVAR. The strict application of EVAR does not increase the mortality from AAA even if the number of open repairs will increase.