Type 2 Endoleak With or Without Intervention and Survival After Endovascular Aneurysm Repair.
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal
/ complications
Aortic Rupture
/ epidemiology
Conservative Treatment
/ statistics & numerical data
Endoleak
/ epidemiology
Endovascular Procedures
/ adverse effects
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Netherlands
/ epidemiology
Reoperation
/ statistics & numerical data
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Abdominal
Aortic aneurysm
Endoleak
Endovascular procedures
Journal
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
ISSN: 1532-2165
Titre abrégé: Eur J Vasc Endovasc Surg
Pays: England
ID NLM: 9512728
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
18
06
2020
revised:
08
12
2020
accepted:
13
01
2021
pubmed:
27
2
2021
medline:
23
6
2021
entrez:
26
2
2021
Statut:
ppublish
Résumé
The aims of the present study were to examine the impact of type 2 endoleaks (T2EL) on overall survival and to determine the need for secondary intervention after endovascular aneurysm repair (EVAR). A multicentre retrospective cohort study in the Netherlands was conducted among patients with an infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between 2007 and 2012. The primary endpoint was overall survival for patients with (T2EL+) or without (T2EL-) a T2EL. Secondary endpoints were sac growth, AAA rupture, and secondary intervention. Kaplan-Meier survival and multivariable Cox regression analysis were used. A total of 2 018 patients were included. The median follow up was 62.1 (range 0.1 - 146.2) months. No difference in overall survival was found between T2EL+ (n = 388) and T2EL- patients (n = 1630) (p = .54). The overall survival estimates at five and 10 years were 73.3%/69.4% and 45.9%/44.1% for T2EL+/T2EL- patients, respectively. Eighty-five of 388 (21.9%) T2EL+ patients underwent a secondary intervention. There was no difference in overall survival between T2EL+ patients who underwent a secondary intervention and those who were treated conservatively (p = .081). Sac growth was observed in 89 T2EL+ patients and 44/89 patients (49.4%) underwent a secondary intervention. In 41/44 cases (93.1%), sac growth was still observed after the intervention, but was left untreated. Aneurysm rupture occurred in 4/388 T2EL patients. In Cox regression analysis, higher age, ASA classification, and maximum iliac diameter were significantly associated with worse overall survival. No difference in overall survival was found between T2EL+ and T2EL- patients. Also, patients who underwent a secondary intervention did not have better survival compared with those who did not undergo a secondary intervention. This study reinforces the need for conservative treatment of an isolated T2EL and the importance of a prospective study to determine possible advantages of the intervention.
Identifiants
pubmed: 33632609
pii: S1078-5884(21)00067-8
doi: 10.1016/j.ejvs.2021.01.017
pii:
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
779-786Investigateurs
Sana Mulay
(S)
R Balm
(R)
J W Elshof
(JW)
B H P Elsman
(BHP)
J F Hamming
(JF)
M J W Koelemay
(MJW)
R H J Kropman
(RHJ)
P P Poyck
(PP)
G W H Schurink
(GWH)
A A E A de Smet
(AAEA)
S M van Sterkenburg
(SM)
C Ünlü
(C)
A C Vahl
(AC)
H J M Verhagen
(HJM)
P W H E Vriens
(PWHE)
J P P M de Vries
(JPPM)
J J Wever
(JJ)
W Wisselink
(W)
C J Zeebregts
(CJ)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.