EVAR of AAA: Long term outcomes, disease progression and risk stratification

Background Endovasvular aortic repair (EVAR) is the most commonly utilised technique for the treatment of abdominal aortic aneurysms (AAA) in tertiary referral centers. Detailed long-term outcomes of this technique are relatively scarce, especially for patients presenting symptomatically with AAA. Intra-operatively, proximal type Ia endoleak, involving blood circulating into the AAA – due to poor proximal seal of the endograft to the aortic neck region – is a feared complication which is usually promptly treated, given its association with post-operative AAA expansion and rupture. Aneurysmatic disease is usually considered a progressive pathology with potential for progression to areas of the aorta beyond the known aneurysmatic segment. Arterial calcifications are established as a marker for atherosclerosis, yet the association of ilio-femoral calcification with post-operative mortality after EVAR is not known. Aims 1. Evaluate the long-term results of EVAR of AAA using a single endograft 2. Compare the early and late results of EVAR of symptomatically presenting patients to those treated asymptomatically 3. Study the long-term results of intra-operative treatment of type Ia endoleak using large, balloonexpandable stents 4. Study the progression of aortic disease for patients treated with endovascular means in the postoperative period 5. Assess the novel ilio-femoral calcium score as a potential predictor for overall and cardiac-specific mortality after EVAR Results EVAR of AAA yields sustainable results in the long-term, for both symptomatic and asymptomatic patients. There is ≈ x4 elevated early mortality in symptomatic patients as compared to asymptomatic ones. Intra-operative treatment of type Ia endoleaks using large, balloon-expandable stents should be reserved to patients treated acutely with EVAR. Aortic expansion beyond the sealing zone is relatively uncommon, and seems related to the force exerted on the aortic wall by the endograft. Ilio-femoral calcium score may predict long-term overall and cardiac mortality after EVAR, albeit the relation is weak. Therefore, further studies are needed to establish this association.