Southern Association For Vascular Surgery

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Short-term Outcomes After Endovascular Repair of Abdominal Aortic Aneurysm (EVAR) using Endoanchors (EA) with Parallel Stent Grafts
Halim Yammine, Jocelyn K. Ballast, Charles S. Briggs, Gregory A. Stanley, Tzvi Nussbaum, Christopher W. Boyes, Frank R. Arko, III
Carolinas Medical Center, Charlotte, NC

BACKGROUND: The purpose of this study was to describe the use of endoanchors in conjunction with parallel stent grafts to manage juxtarenal abdominal aortic aneurysms (AAA). METHODS: Between January 2012 and May 2017, a total of 70 patients underwent EVAR with parallel stenting for AAA, and of these 8 had endoachors as well (EA, n=8). These 8 patients were matched to 16 patients (Controls, n=16) who had parallel stents without endoanchors. Clinical data were collected under an IRB-approved protocol, and statistical analyses were used to analyze endoleaks, gutter size, and change in aneurysm size between groups. RESULTS: Visceral artery stenting for both groups was distributed between one renal artery (50%), two renal arteries (37.5%), and both renal arteries and SMA (12.5%), for a total of 13 vessels in the EA group and 26 in the Control. Comorbidities and demographics were similar between cohorts (Table 1). Endoleak following prior EVAR was the indication for the procedure in 37.5% of EA and 25% of Controls. At presentation, EA had larger diameters (mm) at 1mm and 10mm distal to the lowest renal (28.9(9.3) and 45(13.3)EA, 26.2(6.9) and 35(10.1)Controls) (p=.5 and p=.07), and larger aneurysms (64.5(15.8) EA, 61.7(11.9) Controls, p=.6). Diameter at landing zone and percent oversizing were similar. There were no deaths at 30 days. After EVAR, EA spent fewer days in the hospital (3.75(3.81)EA, 4.89(4.06)Controls, p=.5) and the ICU (0.25(0.46)EA, 2.19(4)Controls, p=.2). Perioperative renal injury occurred in 1 of 8 EA and 3 of 16 Controls (12.5% and 18.75%, p=1). There were no endoleaks or reinterventions noted in EA, while in the Control group, 3 patients had an endoleak (18.75%) and 1 had an aortic reintervention (12.5%). In the EA group, 1 of 13 visceral stents occluded after 244 days, while in the control group 2 of 26 occluded, at 18 and 427 days. At one month, EA had smaller gutters (4.2(1.3)EA, 5.6(1.9)Controls, p=.2), smaller aneurysms (59.7(17.6)EA, 61.5(12.1)Controls, p=.5), a higher percent decrease in aneurysm size (4%(8%)EA, 1%(3%)Controls, p=.2), and fewer patients whose aneurysms increased in size (1(12.5%)EA, 5(31.25%)Controls, p=.6). CONCLUSIONS: Initial experience with EA and parallel stent grafting appears to be safe and effective. Despite more hostile anatomy and larger aneurysms, there was a trend towards better outcomes after parallel stent grafting with concurrent endoanchor placement. The statistical power of this study was limited by the small sample size and short follow-up, but a larger prospective trial may confirm that using endoanchors with parallel stenting can provide improved outcomes.
Table 1: Demographics and Comorbidities*
*All values expressed as mean(SD) or n(%)EA (n=8)Control (n=16)p-value
Age72.88 (8.32)72.81 (7.42)1.0
Male Gender6 (75)9 (56.25)0.7
Coronary Artery Disease3 (37.5)7 (43.75)1.0
Chronic Kidney Disease0 (0)1 (6.25)1.0
Chronic Obstructive Pulmonary Disease3 (37.5)6 (37.5)1.0
Diabetes0 (0)3 (18.75)0.5
Hypertension6 (75)8 (50)0.4
Smoking within the previous year2 (25)8 (50)0.4
Family History of aortic aneurysm3 (37.5)0 (0)0.03

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