A Greek Multicentre Study Assessing the Outcome of Late Rupture After Endovascular Abdominal Aortic Aneurysm Repair

Konstantinos G Moulakakis; Andreas M Lazaris; George S Georgiadis; Stavros Kakkos; Vasileios G Papavasileiou; Constantine N Antonopoulos; Anastasios Papapetrou; Vasilios Katsikas; Chris Klonaris; George Geroulakos; Greek study group on late rupture after EVAR

doi:10.1016/j.ejvs.2023.12.025

A Greek Multicentre Study Assessing the Outcome of Late Rupture After Endovascular Abdominal Aortic Aneurysm Repair

Eur J Vasc Endovasc Surg. 2024 May;67(5):756-764. doi: 10.1016/j.ejvs.2023.12.025. Epub 2023 Dec 26.

Collaborators

Greek study group on late rupture after EVAR:
Kalliopi-Maria Tasopoulou³, Nikolaos Triantafyllou³, Spyros I Papadoulas⁴, Andreas L Tsimpoukis⁴, Christos Stagkoglou⁵, Konstantinos Seretis⁹, Theophanis T Papas⁹, Paraskevi Tsiantoula⁹, John D Kakisis², George Sfyroeras², Chrysostomos Maltezos⁶, George Kopadis⁷, Petros K Chatzigakis⁷, Athanasios Katsargyris⁸, Natasha Hasemaki⁸, Ioannis Bountouris¹⁰, Georgios Theocharopoulos¹⁰

Affiliations

¹ Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, University of Patras Medical School, Patras, Greece. Electronic address: konmoulakakis@yahoo.gr.
² Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
³ Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
⁴ Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
⁵ Department of Vascular Surgery, Sismanoglio General Hospital of Athens, Athens, Greece.
⁶ Hellenic Vascular Registry (HEVAR); Vascular Surgery Clinic, K.A.T. General Hospital, Athens, Greece.
⁷ Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, Gennimatas General Hospital of Athens, Athens, Greece.
⁸ Hellenic Vascular Registry (HEVAR); 2nd Department of Vascular Surgery, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece.
⁹ Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, Hellenic Red Cross Hospital, Athens, Greece.
¹⁰ Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery Unit, 251 Hellenic Air Force Hospital Athens, Athens, Greece.

PMID: 38154499
DOI: 10.1016/j.ejvs.2023.12.025

Abstract

Objective: Late rupture after endovascular aortic aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA) is an increasing complication associated with a high mortality rate. This study aimed to analyse the causes and outcomes in patients with AAA rupture after EVAR.

Methods: A multi-institutional Greek study of late ruptures after EVAR between 2008 - 2022 was performed. Primary outcomes were intra-operative and in hospital death.

Results: A total of 70 patients presented with late rupture after EVAR (proportion of ruptured EVARs among all EVARs, 0.6%; 69 males; mean age 77.2 ± 6.7 years). The mean time interval between EVAR and late rupture was 72.3 months (range 6 - 180 months). In all cases the cause of rupture was the presence of an endoleak (type I, 73%) with sac enlargement. Moreover, 34% of subjects with rupture after EVAR had been lost to follow up and 32% underwent a secondary intervention. Additionally, 57 patients (81%) were treated by conversion to open surgical repair (COSR) and the remainder by endovascular correction of endoleak (ECE). Eleven intra-operative deaths (16%) were recorded. The overall in hospital mortality rate was 41% (23% ECE vs. 46% COSR; p = .21). Of the patients who presented as initially haemodynamically stable, 23% died during hospitalisation, while the respective mortality rate for patients who presented as unstable was 78% (odds ratio [OR] 11.8, 95% confidence interval [CI] 3.6 - 39.1; p < .001). Multivariable logistic regression analysis revealed that severity of haemodynamic shock was the most significant risk factor for intra-operative (OR 7.15, 95% CI 1.58 - 32.40; p = .010) and in hospital death (OR 9.53, 95% CI 2.79 - 32.58; p < .001).

Conclusion: These data underline the devastating prognosis of late rupture after EVAR. Haemodynamic status at presentation was an important predictive factor for death both in the ECE and COSR groups. Rigorous follow up and prompt evaluation of an unstable patient in case of rupture after EVAR is recommended.

Keywords: Aorta; EVAR; Endovascular; Repair; Rupture.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal* / mortality
Aortic Aneurysm, Abdominal* / surgery
Aortic Rupture* / etiology
Aortic Rupture* / mortality
Aortic Rupture* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / mortality
Endoleak* / etiology
Endoleak* / mortality
Endoleak* / surgery
Endovascular Procedures* / adverse effects
Endovascular Procedures* / mortality
Female
Greece / epidemiology
Hospital Mortality*
Humans
Male
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome