Study Reviews Long-Term Branch Durability After Complex EVAR

June 8, 2012—According to the Society for Vascular Surgery (SVS), a study showed that branches following complex aortic aneurysm repair appear to be durable and are rarely the cause of patient death following complex aortic aneurysm repair. The study was presented at the SVS 2012 Vascular Annual Meeting in National Harbor, Maryland.

SVS stated that Tara Mastracci, MD, from The Cleveland Clinic Foundation in Cleveland, Ohio, reviewed findings from her group's study. The investigators gathered prospective data from 650 patients who underwent endovascular aortic repair with branched or fenestrated devices between 2001 and 2010. 

Dr. Mastracci commented in the SVS press release, “This physician-sponsored investigational device exemption trial included imaging studies and electronic records to supplement the dataset when necessary. Branch stent reintervention, endoleak repair, stent fracture, migration, rupture, and death were calculated. Time to event analysis was performed for a composite endpoint of reintervention for any branch. Univariable and multivariable analysis was performed to identify related variables and device failure was reported as a function of exponential decay to capture the loss of freedom from complications over time.” 

 As summarized in the SVS announcement, the investigators reported that through 9 years of follow-up (mean, 3 years; standard deviation [SD], 2.3]) secondary procedures were performed for 0.6% of celiac, 4% of superior mesenteric artery (SMA), 6% of right renal, and 5% of left renal artery stents. The mean time to reintervention was 237 days (SD, 354 days). 

The 30-day, 1-year, and 5-year freedom from any branch intervention was 98% (95% confidence interval [CI], 96%–99%), 94% (95% CI, 92%–96%), 84% (95% CI, 78%–90%) respectively. Death resulted from branch stent complications in two patients and was related to SMA thrombosis. Multivariable analysis revealed no factors as independent predictors of branch reintervention. “The absence of long-term data on branch patency in open repair precludes comparison, yet the lower morbidity and mortality risk coupled with longer-term durability data will further alter the balance of repair options,” advised Dr. Mastracci in the SVS press release.