Aneurysm Aortic, Vascular Diseases
Conditions
Keywords
F-BEVAR, Open surgery, complex abdominal aortic aneurysm
Brief summary
The aim of the present study was to investigate outcomes of a propensity matched series of patients treated with F-BEVAR and open surgery repair for complex abdominal aortic aneurysm in two aortic high-volume centres.
Detailed description
This retrospective study analyzes the long-term outcomes of a propensity-matched cohort of patients with complex abdominal aortic aneurysm prospectively collected between January 2010 and June 2016 from the Aortic Center of Lille (Lille, France) and the Unit of Vascular Surgery of Policlinic Gemelli (Rome, Italy). Patients were observed with regular postoperative appointments. The long-term imaging follow-up consisted in a yearly computed tomography angiography in the F-BEVAR group; and yearly abdominal ultrasound examination and 5-year computed tomography angiography were performed in the open surgery repair group. In case of abnormal renal function (eGFR\<60 mL/min/1.73 m2), the patient underwent computed tomography without contrast associated to a contrast-enhanced ultrasound examination in both groups. Laboratory data with evaluation of renal function by estimated glomerular filtration rate (eGFR), were completed at three, six, and 12 months, and yearly thereafter. Survival assessment was completed after general partitioner's, patients' or patient siblings' contact by phone.
Interventions
PROCEDUREFenestrated and branched endovascular aortic repair (F-BEVAR)
Fenestrated and branched endovascular aortic repair (F-BEVAR)
PROCEDUREOpen repair
Open surgery for complex abdominal aortic aneurysm
Sponsors
Centre Chirurgical Marie Lannelongue
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* juxtarenal abdominal aortic aneurysms * pararenal abdominal aortic aneurysms * suprarenal abdominal aortic aneurysms * type IV thoracoabdominal aneurysms
Exclusion criteria
* extent I to III thoracoabdominal aneurysms * ruptured o symptomatic aneurysms * dissections or connective tissue disorder aneurysms.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall mortality | Through study completion, an average of 5 year | All cause death |
| Aortic-related mortality | Through study completion, an average of 5 year | Any death related to the initial procedure. |
| Chronic renal decline during follow-up | Through study completion, an average of 5 year | Chronic renal decline was defined in patients with normal (stage 1-2) preoperative renal function as a reduction in the eGFR to \<60 mL/min/1.73 m2 during follow-up. In patients with abnormal function (stages 3 and 4) preoperatively, it was defined as an eGFR reduction of \>20% or de novo dependence on permanent renal replacement therapy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Aortic-related reintervention | Through study completion, an average of 5 year | All secondary interventions related to the initial procedure or to the endograft and its target vessels during follow-up |
| Proximal aorta degeneration Proximal aorta degeneration | Through study completion, an average of 5 year | Diameter increase \>5 mm within 5 cm above the ostium of the more proximal target vessel for the endovascular group and 5 cm above the proximal anastomosis for the open group |
| Target vessel occlusion | Through study completion, an average of 5 year | Complete obstruction of the artery with no evidence of flow identified on any follow-up CT scan or duplex ultrasound. |
| Clinical failure | Through study completion, an average of 5 year | Death from complications of the initial operation or a secondary intervention, aortic aneurysm rupture, aortic conversion to open surgical repair, persistent type I or III endoleak, sac expansion \>5 mm, device migration \>10mm, infection or thrombosis in the F-BEVAR group and death, graft infection or thrombosis or para-anastomotic aneurysm in the open group. |
Outcome results
None listed