Incidence and Factors Associated with Aortic SAC Reduction after Evar in Spanish Population

Introduction: This study aimed to know the incidence and factors associated with aneurysmal sac reduction (ASR) after endovascular aneurysm repair (EVAR) at 3 years of follow up in the Spanish population.

Material and Methods: This is a retrospective observational study. We analyzed all patients with abdominal aortic and aortoiliac aneurysms who underwent elective EVAR in our hospital between January 2007 and September 2015. We studied ASR incidence at 3 years of follow-up. ASR was defined as a reduction in sac diameter ≥ 5 mm. Multiple preoperative and postoperative variables were analyzed. We used chi2 and T student tests for statistical analysis. Kaplan-Meier survival analysis and actuarial analysis were performed.

Results: Three hundred one patients underwent EVAR. The majority was men (97.3%) with a mean age of 74 ± 8 years, and 77.4% were at high surgical risk according to the American Society of Anesthesiologists classification (ASA). There was an incidence of 51.6% ASR at 3 years of follow up. Patients under chronic anticoagulation had 60% ASR vs 50.5%, p = 0.489. An aortic neck> 20 mm in length was associated with 55.3% ASR vs 45.7%, p = 0.303. Patients with ASR were younger 71 ± 8 years vs 76 ± 6 years, (P = 0.001, 95% CI, -7-1.9). Type II endoleak was associated with lower ASR, 32.4% vs 60, 8%, p = 0.006. Overall survival at 6, 12, 24 and 36 months was 90%, 82%, 71% and 61%, respectively. Survival in patients with ASR was better than patients without ASR, p = 0.008.

Conclusions: ASR incidence after EVAR was high in our series and was associated with increased survival rate. The overall survival at medium term was good despite the high surgical risk of our series.