Initial two-day blood pressure management after endovascular aneurysm repair improves midterm outcomes by reducing the incidence of early type II endoleak

Shuhei Miura; Yoshihiko Kurimoto; Ryushi Maruyama; Masanori Nojima; Keita Sasaki; Takahiko Masuda; Naritomo Nishioka; Yutaka Iba; Nobuyoshi Kawaharada; Syuichi Naraoka

doi:10.1016/j.jvs.2023.10.003

Initial two-day blood pressure management after endovascular aneurysm repair improves midterm outcomes by reducing the incidence of early type II endoleak

J Vasc Surg. 2024 Feb;79(2):251-259.e2. doi: 10.1016/j.jvs.2023.10.003. Epub 2023 Oct 10.

Affiliations

¹ Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan. Electronic address: smiura1024@outlook.jp.
² Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
³ The Institute of Medical Science Hospital, University of Tokyo, Tokyo, Japan.
⁴ Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.

PMID: 37827245
DOI: 10.1016/j.jvs.2023.10.003

Abstract

Objective: The aim of this study was to evaluate midterm outcomes of our novel strategy of postoperative initial 2-day blood pressure management (BPM) after endovascular aneurysm repair (EVAR) for the prevention of subsequent type II endoleak (T2EL) in a single-center series.

Methods: Between 2008 and 2014, 137 patients who underwent EVAR for abdominal aortic aneurysm (AAA) were reviewed. Starting from 2013, the mean blood pressure was maintained between 75 and 90 mmHg for the initial 24 hours after EVAR followed by systolic pressure controlled below 120 mmHg during the next 24 hours in the treatment group (n = 76). The incidence of T2EL detected at 7 days, reintervention, and AAA sac diameter up to 5 years after EVAR were compared with those of the control group comprising of 60 consecutive patients who underwent standard EVAR without BPM prior to 2013.

Results: Between the treatment group and the control group, significant differences were achieved in the incidence of T2EL at 7 days (19.7% vs 40.0%; P = .009), a mean decrease of AAA sac diameter at 1-year (-5.1 ± 4.9 vs -2.2 ± 6.7 mm; P = .013) and 2-year (-5.4 ± 7.7 vs -1.7 ± 10.8 mm; P = .045). In addition, there was a significant decrease in the incidence of T2EL detected at 7 days with the use of the Gore Excluder with 22.7% in the treatment group vs 80.0% in the control group (P < .001), which resulted in a significant decrease in the aneurysm sac diameter up to 4 years after EVAR. Survival rate without AAA sac enlargement at 5 years after EVAR (83.0% vs 70.0%; P = .021) in the treatment group was significantly higher than that of the control group, whereas no significant differences were observed in the freedom rates of reintervention, T2EL-related reintervention, and all-cause mortality between the groups.

Conclusions: Postoperative initial 2-day BPM had a preventive effect on AAA sac enlargement until midterm periods, by reducing the incidence of T2EL at 7 days after EVAR. The usage of Gore Excluder under BPM was especially associated with sustained positive effects until the midterm follow-up.

Keywords: Abdominal aortic aneurysm; Endovascular aneurysm repair; Postoperative initial 2-day blood pressure management; Type II endoleak.

MeSH terms

Aortic Aneurysm, Abdominal* / complications
Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / surgery
Blood Pressure
Blood Vessel Prosthesis Implantation* / adverse effects
Endoleak / epidemiology
Endoleak / etiology
Endoleak / prevention & control
Endovascular Aneurysm Repair
Endovascular Procedures* / adverse effects
Humans
Incidence
Retrospective Studies
Risk Factors
Treatment Outcome