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

Detta är en avhandling från Lund University, Faculty of Medicine

Sammanfattning: BackgroundEndovasvular aortic repair (EVAR) is the most commonly utilised technique for the treatment of abdominal aorticaneurysms (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, involvingblood circulating into the AAA – due to poor proximal seal of the endograft to the aortic neck region – is a fearedcomplication which is usually promptly treated, given its association with post-operative AAA expansion andrupture. Aneurysmatic disease is usually considered a progressive pathology with potential for progression toareas of the aorta beyond the known aneurysmatic segment. Arterial calcifications are established as a marker foratherosclerosis, yet the association of ilio-femoral calcification with post-operative mortality after EVAR is notknown.Aims1. Evaluate the long-term results of EVAR of AAA using a single endograft2. Compare the early and late results of EVAR of symptomatically presenting patients to those treated asymptomatically3. Study the long-term results of intra-operative treatment of type Ia endoleak using large, balloon expandable stents4. Study the progression of aortic disease for patients treated with endovascular means in the postoperative period5. Assess the novel ilio-femoral calcium score as a potential predictor for overall and cardiac-specific mortality after EVARResultsEVAR of AAA yields sustainable results in the long-term, for both symptomatic and asymptomatic patients. Thereis ≈ x4 elevated early mortality in symptomatic patients as compared to asymptomatic ones. Intra-operativetreatment of type Ia endoleaks using large, balloon-expandable stents should be reserved to patients treatedacutely with EVAR. Aortic expansion beyond the sealing zone is relatively uncommon, and seems related to theforce exerted on the aortic wall by the endograft. Ilio-femoral calcium score may predict long-term overall andcardiac mortality after EVAR, albeit the relation is weak. Therefore, further studies are needed to establish thisassociation.