Long-Term Outcomes of Simple Endovascular Aneurysm Repair Based on the Initial Aortic Diameter

Purpose: We aimed to investigate the effects of initial abdominal aortic aneurysm (AAA) diameter on aneurysmal sac expansion/shrinkage, endoleaks, and reintervention post-elective simple endovascular aneurysm repair (EVAR).Methods: Overall, 228 patients monitored for >1 year after EVAR were analyzed. Male and female participants with initial AAA diameters <55 mm and <50 mm, respectively, composed the small group (group S), while those with initial AAA diameters >= 55 mm (men) and >= 50 mm (women) composed the large group (group L). Aneurysmal sac expan-sion of 10 mm and/or reintervention during follow-up (composite event) and its related factors were evaluated.Results: The 5-year freedom from composite event rate was significantly higher in group S (92.4 +/- 2.8%) than that in group L (79.1 +/- 4.9%; P <0.01). Multivariate analysis revealed AAA diameters before EVAR in group S (hazard ratio, 0.38; 95% confidence interval, 0.18-0.81; P = 0.01) and type II endoleak (T2EL) at discharge (hazard ratio, 2.83; 95% confidence interval, 1.29-6.20; P <0.01) as factors associated with the composite event. The freedom from composite event rate decreased to 51 +/- 13% at 5 years in group L with T2EL.Conclusions: Group S had high freedom from composite event rate; in group L, the rate decreased to 51% at 5 years with T2EL at discharge.