Long-term Analysis of Standard Abdominal Aortic Endovascular Repair Using Different Grafts Focusing on Endoleak Onset and Its Evolution.

Objective: To report long-term results of standard EVAR focusing on endoleak onset (ELo) and its evolution. Methods: 880 EVARs using different stentgrafts (1999-2015) were included. Primary outcomes were all-cause mortality and AAA-related mortality. Timing of ELo after EVAR was categorized as follows: ELo1=0-2 years, ELo2=2-4 years, ELo3=4-6 years, ELo4=6-8 years, and ELo5=8 years. The rate of sac shrinkage/sac expansion and the need to re-intervene were the variables considered to determine EL evolution. Results: Median follow-up was 60 months (IQR: 36-84). Summary follow-up index was 0.99. Survival rate was 94.5% at 2 years, 57.7% at 10 years, 33.3% at 14 years. Freedom from AAA-related-death rate was 99.3% at 14 years. Freedom from endoleak was 86.4% at 2 years, 68.3% at 10 years, and 48.6% at 14 years. EL rate was 1.9% (n=19), 16.6% (n=146), 0.8% (n=7), and 0.4% (n=4) for type I, II, III and IV, respectively. Only type II EL showed a significant difference in the ELo (Elo1=31%; ELo2=12.8%; ELo3=9.4%; Elo4=10.2%; Elo5=11.4%; P<.001). Sac shrinkage occurred in 791 (90%) patients while 89 (10%) had a persistent sac expansion at the last follow-up. Freedom from reintervention was 95.6% at 2 years, 86.4% at 10 years, and 80% at 14 years. 48 out of 176 (27.2%) patients with EL underwent reintervention. The re-intervention rate was significantly higher within the first two years of follow-up if compared to the following years (17.6% vs. b10%; P<.001). Conclusions: An active lifelong surveillance follow-up can guarantee good long-term EVAR outcomes. Reinterventions and type II EL were more frequent in the first two-year of follow-up. (c) 2018 Elsevier B.V. All rights reserved.