Outcome of Tubular Aortoaortic Endografts in Infrarenal Aneurysmal Disease and Penetrating Abdominal Aortic Ulcers-a Long-Term Follow-up.

Engelberger, Stephan; Prouse, Giorgio; Riva, Francesca; Van den Berg, Josua Cornelis; Giovannacci, Luca (2020). Outcome of Tubular Aortoaortic Endografts in Infrarenal Aneurysmal Disease and Penetrating Abdominal Aortic Ulcers-a Long-Term Follow-up. Annals of vascular surgery, 62, pp. 206-212. Elsevier 10.1016/j.avsg.2019.06.032

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BACKGROUND

We describe the long-term follow-up of patients treated for infrarenal abdominal aortic aneurysms and penetrating ulcers by placement of tubular aortic endografts at our institution from 2010 to present.

METHODS

This is a retrospective study using clinical data of patients treated from 2010 to present by placement of either a single aortic tubular endograft or by two overlapping endografts, using the "trombone technique." Aortic dimensions were measured from the preoperative computed tomography scans using three-dimensional reconstruction. The primary outcome was aortic reintervention. Secondary outcomes were aorta-related mortality, endoleaks, and postoperative complications.

RESULTS

Twenty-eight patients were identified. Nine patients were treated for saccular aneurysms, and nineteen patients presented with penetrating aortic ulcers. The median follow-up was 31 months (range: 4-99). Twenty patients were treated with a single tubular device, while eight patients were treated using two overlapping devices. Aortic reintervention occurred in four patients (14.3%), all were treated initially with a single device. No aortic mortality occurred during follow-up. No aneurysm ruptures occurred. Four patients died during follow-up of unrelated causes. Endoleaks occurred in ten patients (35%). Five endoleaks were of type I (17.8%), of which three were of distal type (10.7%). Five endoleaks were of type II (17.8%). Shorter distal landing zones than 20 mm were present in two of the cases with a distal type I endoleak (P = 0.0232). Postoperative complications occurred in three (10.7%) patients including one myocardial infarction and two wound complications from a surgical cut down in the groin.

CONCLUSIONS

The technique shows an acceptable postoperative complication rate but is characterized by high rate of occurrence of type I endoleaks and aortic reintervention in our series. Endovascular techniques using tubular endografts should be limited to cases with long proximal and distal sealing zones. The trombone technique seems preferable.

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