The Long-term Durability of Intra-operatively Placed Palmaz Stents for the Treatment of Type la Endoleaks After EVAR of Abdominal Aortic Aneurysm

Objective/Background: The objective was to analyze the long-term durability of intra-operatively placed Palmaz stents for type la endoleaks, and the evolution of aneurysm neck morphology. Methods: This was a retrospective cohort study conducted at a tertiary referral centre. Patients treated between 1998 and 2012 were reviewed with regard to pre-, intra-, and post-operative data. Crude and relative survival estimates were calculated, with the latter referring only to patients with >= 3 months' follow-up. Results: In total, 125 patients were included (83 elective, 22 ruptures, 20 symptomatic). Nine patients died perioperatively (two elective, seven acute). Median follow-up was 43 months (range 15-72). Seven patients had late abdominal aortic aneurysm related deaths. There were 51 re-interventions (seven type la endoleak related). Five year crude primary, primary assisted, and secondary success rates were 55 +/- 5%, 66 +/- 5%, and 70 +/- 5%, respectively. These crude rates were superior for elective patients (p=.008, p=.031, and p=.037, respectively), but the relative rates were not (p=.187, p=.640, p=.558, respectively). Primary and assisted freedom from type la endoleak 5 years post-operatively were 84 +/- 4% and 89 +/- 3%, respectively. These rates were superior in elective patients (p=.066 and p=.145, respectively), especially when relative rates were analysed (p=.025 and p=.063, respectively). The visceral aortic diameter increased significantly between the first and the last post-operative imaging in 15/91 (16%), 12/91 (13%), 34/91 (37%), and 30/91 (33%) patients at the levels of coeliac trunk, superior mesenteric artery, lowest renal artery, and 9 mm distal to lowest renal artery, respectively. Conclusion: Intra-operatively placed Palmaz stents confer high long-term freedom from type la endoleak. Palmaz stents are an acceptable intra-operative bailout tool in the acute setting, but should not be used to extend elective infrarenal endovascular aneurysm repair to more demanding anatomies. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.