Short-Term Re-intervention of Endovascular Abdominal Aortic Aneurysm Repair

Hesham Soliman; Mohamed Elkorety; Mohamed Abouelazayem; Girish Girish

doi:10.7759/cureus.16810

Short-Term Re-intervention of Endovascular Abdominal Aortic Aneurysm Repair

Cureus. 2021 Aug 1;13(8):e16810. doi: 10.7759/cureus.16810. eCollection 2021 Aug.

Authors

Hesham Soliman¹, Mohamed Elkorety², Mohamed Abouelazayem³, Girish Girish²

Affiliations

¹ Department of General Surgery, Kings College NHS Foundation Trust, London, GBR.
² Department of General Surgery, West Hertfordshire Hospitals NHS Trust, Watford, GBR.
³ Department of General Surgery, St George's University Hospitals NHS Foundation Trust, London, GBR.

Abstract

Background and aim Endovascular aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysm (AAA). The re-intervention rate following EVAR has been a subject of debate in many studies. The study aims to evaluate the short-term outcomes in terms of the early (four-year) re-intervention rate following EVAR at our centre and compare it to the average re-intervention rate of the main studies assessed by the National Institute of Health and Care Excellence (NICE). Methods The EVAR procedures performed over two years (2015 and 2016) were retrieved using the operation codes. The clinical portal and PACS systems were used to review the discharge summaries, clinic and multidisciplinary team (MDT) letters, as well as the scans and interventional radiology procedures to assess the patients' adherence to follow-up and identify any re-intervention procedure done to correct underlying problems related to the EVAR performed. Patients who switched their follow-up to another hospital were contacted and interviewed about any re-intervention undergone. Results A total of 108 patients underwent EVAR during the two-year study period. Twenty EVAR-related re-interventions (18.5%) were recorded, irrespective of the cause or the type of intervention. This is slightly higher than the average rate by NICE (16.89%). Type 1 endoleak represented the leading cause for re-intervention (30%). Most of the cases of re-intervention were done endovascularly (60%). Forty-five percent of the patients had a re-intervention during the first year and 35% in the third year. Conclusion This study shows that although our re-intervention rate following EVAR was slightly higher than the international average, EVAR is still a safe method for the repair of AAA with relatively low peri-operative morbidity and mortality. However, long-term follow-up of these patients is mandatory as re-interventions are frequently required. Nonetheless, the majority of re-interventions can be done with minimal morbidity to the patient.

Keywords: abdominal aortic aneurysm; endo vascular intervention; endovascular; evar; re-intervention.