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Ketting S, Zoethout AC, Heyligers JMM, et al. Nationwide experience with EVAS relining of previous open or endovascular AAA treatment in the Netherlands. Ann Vasc Surg. 2022;doi: 10.1016/j.avsg.2021.12.077.
Ketting, S., Zoethout, A. C., Heyligers, J. M. M., Wiersema, A. M., Yeung, K. K., Schurink, G. W. H., Verhagen, H. J. M., de Vries, J. P. M., Reijnen, M. M. P. J., & Mees, B. M. E. (2022). Nationwide experience with EVAS relining of previous open or endovascular AAA treatment in the Netherlands. Annals of vascular surgery, . https://doi.org/10.1016/j.avsg.2021.12.077
Ketting, Shirley, et al. "Nationwide experience with EVAS relining of previous open or endovascular AAA treatment in the Netherlands." Annals of vascular surgery vol. (2022). doi: https://doi.org/10.1016/j.avsg.2021.12.077
Ketting S, Zoethout AC, Heyligers JMM, Wiersema AM, Yeung KK, Schurink GWH, Verhagen HJM, de Vries JPM, Reijnen MMPJ, Mees BME. Nationwide experience with EVAS relining of previous open or endovascular AAA treatment in the Netherlands. Ann Vasc Surg. 2022 Jan 05; doi: 10.1016/j.avsg.2021.12.077. Epub 2022 Jan 05. PMID: 34998936.
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Ann Vasc Surg. 2022 Jan 05; doi: 10.1016/j.avsg.2021.12.077. Epub 2022 Jan 05.

Nationwide experience with EVAS relining of previous open or endovascular AAA treatment in the Netherlands.

Annals of vascular surgery

Shirley Ketting, Aleksandra C Zoethout, Jan M M Heyligers, Arno M Wiersema, Kak K Yeung, Geert W H Schurink, Hence J M Verhagen, Jean-Paul P M de Vries, Michel M P J Reijnen, Barend M E Mees

Affiliations

  1. Department of Vascular Surgery, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
  2. Department of Surgery, Rijnstate, Arnhem, The Netherlands; Department of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands.
  3. Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands.
  4. Department of Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands.
  5. Department of Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, the Netherlands.
  6. Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
  7. Department of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
  8. Department of Surgery, Rijnstate, Arnhem, The Netherlands; Multi-Modality Medical Imaging Group, University of Twente, Enschede, the Netherlands.
  9. Department of Vascular Surgery, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands. Electronic address: [email protected].

PMID: 34998936 DOI: 10.1016/j.avsg.2021.12.077

Abstract

OBJECTIVE: Relining of a previously placed surgical graft or endograft for an abdominal aortic aneurysm (AAA) is a reintervention to treat progression of disease or failure of the primary (endo)graft. Endovascular Aneurysm Sealing (EVAS) relining is a technique with potential advantages due to the absence of a bifurcation, the possibility for a unilateral approach, and sealing concept of the endobags. The purpose of this study was to describe the nationwide experience with EVAS relining of previous AAA repair in the Netherlands.

METHODS: A retrospective analysis of all patients who underwent EVAS relining in seven high volume vascular centres in the Netherlands between 2014 and 2019 was performed. Primary outcomes were technical and clinical success. Secondary outcomes were perioperative outcomes, complications and survival.

RESULTS: Thirty-three patients underwent EVAS relining of open (n=10) or endovascular (n=23) repair. Twenty-six were elective cases, five were urgent and two were acute (ruptured). Mean time between primary treatment and EVAS relining was 99±74 months. Indications after open repair were proximal progression of disease (n=7) and graft defect (n=3). Indications after EVAR were type IA (n=10), type IB (n=3), type IIIA (n=4), type IIIB (n=3) endoleak, and endotension (n=3). Eighteen patients underwent regular EVAS, four unilateral EVAS and 11 chimney-EVAS. In-hospital mortality was 6% (both patients with rAAA). Technical success was achieved in 97%. Median follow-up after EVAS relining was 20 months (range 0-43). Freedom from reintervention at one-year and two-year were 83% and 61% and the estimated survival 79% and 71%, respectively. EVAS relining after open repair had a clinical success of 90% at one-year and of 70% at latest follow-up, while after EVAR clinical success rates were 70% and 52%, respectively.

CONCLUSION: EVAS relining of previous AAA repair is associated with high technical success, however with low clinical success at median follow-up of 20 months. Clinical success was higher in patients with EVAS relining after open repair than after EVAR. In patients with failed AAA repair, EVAS relining should only be considered, when established techniques such as fenestrated repair or open conversion are not available or indicated.

Copyright © 2022. Published by Elsevier Inc.

Keywords: abdominal aortic aneurysm; endoleak; endovascular aneurysm repair; endovascular aneurysm sealing; open aneurysm repair; reintervention

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