Factors associated with short- and intermediate-term endoleak development

after EVAR with the use of new generation endografts

Athanasios D. Giannoukas MD, MSc(Lond.), PhD(Lond.), FEBVS

Professor of Vascular Surgery Faculty of Medicine, University of Thessalia, Greece

Chairman, Dept. of Vascular Surgery, University Hospital of Larissa Larissa, Greece

• No Conflict of Interest

• First use of endografts in 1986 by

Volodos and in 1991 by Parodi • Initially the endografts were aorto-aortic

tube grafts with high failure rates due to aortic neck anatomy and aortic disease progression

• Endografts have been evolved. 1) Volodos NL, Shekhanin VE, Karpovich IP, Trojan VI, Gur’ev IuA. A self-fixing synthetic blood vessel endoprosthesis. Vestn Khir Im II Grek 1986;137(11):123-5 Article in Russian 2) Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5(6):491-9

Evolution of modular endografts (2 pieces- 3 pieces) – 1st and 2nd generation.

Effective proximal sealing in EVAR remains the cornerstone

Failure to achieve it has serious consequence

The refinements in the design of the new generation endografts were mostly aiming to provide active fixation and conformable deployment in difficult anatomic situations eliminating the defects of the past generations in the proximal fixation.

Delivery Systems – Active fixation last generation

• flexible systems, • with hydrophilic coating, • low profile, • accurate deployment, • repositionable

Factors associated with immediate and short (1-year) endoleak after EVAR with

the use of new generation endografts

Saleptsis V1, Spanos K1, Antonopoulos K2, Karkos C3, Ioannou C4, Tsetis D5, Kakissis I2, Papazoglou K3, Liapis C2, Giannoukas A1

1 University Hospital of Larisa, Greece 2 University Hospital "Attikon” of Athens, Athens, Greece 3 5th General Surgical Department of “Hippokration” Hospital of Thessaloniki, Thessaloniki, Greece 4 Vascular Surgery Unit of University Hospital of Heraklion Crete, Heraklion, Greece 5 Radiology Department of University Hospital of Heraklion Crete, Heraklion, Greece

4 Vascular Departments,

400 patients • University Hospital of Larissa, Thessaly,

Greece (119/400) • University Hospital "Attikon” of Athens,

Athens, Greece (50/400) • 5th General Surgical Department of

“Hippokration” Hospital of Thessaloniki, Thessaloniki, Greece (208/400)

• Vascular Surgery Unit of University Hospital of Heraklion Crete, Heraklion, Greece (23/400)

Objectives We conducted this multicenter study to assess: the immediate (1-month) and short (1-year)

outcome with the use the new generation endografts implemented in endovascular repair (EVAR) over the last years.

factors associated with development of Endoleak.

Methods

Multicentre retrospective analysis of

prospectively collected data CT scanning was performed on 1st month

and 1st year. Multivariate and logistic regression

analysis was undertaken.

Patients demographics and

risk factors Patients n:400

Sex 95.2% Males (381/400)

Age 71.3±7.9 (Male:71.23, Female:72.7)

Smoking 56.25% (225/400)

Hypertension 74.5% (298/400)

Hyperlipidemia 33% (132/400)

Diabetes Mellitus 9% (36/400)

Coronary Artery Disease 47% (188/400)

AAA characteristics

AAA diameter 57.13± 12.54mm Neck diameter 24.6± 3.08mm Neck length

<15mm <10mm

28.99± 19.93mm

46 (11.5%) 11 (2.75%)

Neck angle >60 8% (32/400)

Elective 87.25% (349/400) Urgent 12.75% (51/400)

Types of Endografts Stent Graft System Frequency Percent

Anaconda 30 7.5 Aorfix 7 1.6 Evita 1 0.3

Gore Excluder 212 53 Gore Excluder C3 3 0.9

Ovation 13 3.3 Cook Zenith 32 8

Medtronic Talent 13 3.3 Medtronic Endurant 81 20.3

Missing 8 1.8 Total 400 100

Results • Type 1a Endoleak 1st month CTA: 13 (3.25%) (6 suprarenal fixation) 1st year CTA: 4 persisted and 2 new developed In logistic regression analysis type 1a Endoleak was associated with: Sac diameter > 55mm (p=0.031) Neck diameter >30 mm (p=0.032) No association with neck length <15mm

Results

• Type 2 Endoleak 1st month CTA: 75 (18.75%) 1st year CTA: 81 (20.25%)

• No association was found among type 2

endoleak and any endograft or AAA geometric characteristics

Results • Type 1b Endoleak 1st month CTA: 1 case treated immediately 1st year CTA: nil • Limb thrombosis (1 year): 4 cases (1%)

Results:

• Sac expansion on 1st year: 26.75%

(107/400)

• It was associated with the presence of Endoleak type1a and 2 (p=0.019)

Leak not identified in 8 cases

• No rupture occurred during 1 year follow up.

Discussion

Discussion

Discussion

Discussion

Discussion

• Although

Discussion

Discussion

Conclusions

• New generation endografts appear to perform

satisfactorily in short-term even in unfavourable anatomic conditions

• 1-month and 1-year risk of type 1a endoleak is low, and it is associated only with the initial sac (>55mm) and proximal neck diameter (>30mm). Such characteristics may be used to select EVARs that require more intense F-UP

Conclusions

• Endoleak type 2 is not related to any endograft or AAA geometric characteristics.

• Although endoleak type 2 does not seem to increase risk of rupture in 1 year post-EVAR it is associated with sac expansion and thus it requires close surveillance as its natural history is not currently well-defined

Thanks for the attention