Predictive factors for limb occlusions after endovascular aneurysm repair
Elsa M Faure, Jean-Pierre Becquemin, Frédéric Cochennec, ENGAGE collaborators, Ricardo Garcia Monaco, Mariano Ferreira, Rob Fitridge, Nick Boyne, Steve Dubenec, Michael Grigg, Patrice Mwipatayi, Thomas Rand, Patrick Peeters, Marc Bosiers, Jeroen Hendriks, Frank Vermassen, Min Lee, Tom Forbes, Oren Steinmetz, Yvan Douville, Leonard Tse, Wei Guo, Jichun Zhao, Jianfang Luo, Jaime Camacho, Jiri Novotny, Dominique Midy, Jean-Pierre Becquemin, Emmanuel Choukroun, Dittmar Bockler, G Torsello, Gerhard Hoffmann, Kostantinos Papazoglou, Dimitris Kiskinis, Stephen Cheng, Yehuda Wolf, Andrea Stella, Carlo Pratesi, Carlo Setacci, Jae Kyu Kim, Do Yun Lee, Valdas Bilkis, Steven van Sterkenburg, Joep Teijink, Rob Welten, Jean-Paul de Vries, Hence Verhagen, Jan Heijligers, Andrew Hill, Thodur Vasudevan, Guttorm Jenssen, Eric Dorenberg, Rolf Busund, Piotr Gutowski, Walerian Staszkiewicz, Joao Albuquerque e Castro, Ivan Vulev, Phillip Matley, Corstiaan Leendert Punt, Jacobus Van Marle, V Riambau, Eduardo Ros, Aurelio Garcia de la Torre, Francisco Gomez Palons, Carlos Vaquero Puerta, Hakan Roos, Thomas Larzon, Martin Delle, Do Dai-Do, Juerg Schmidli, Boonprasit Kritpracha, Furuzan Numan, Yigit Goktay, Levent Oguzkurt, Paul Hayes, Richard McWilliams, Matt Thompson, Ray Ashleigh, John Rose, Carmelo Gastambide, Elsa M Faure, Jean-Pierre Becquemin, Frédéric Cochennec, ENGAGE collaborators, Ricardo Garcia Monaco, Mariano Ferreira, Rob Fitridge, Nick Boyne, Steve Dubenec, Michael Grigg, Patrice Mwipatayi, Thomas Rand, Patrick Peeters, Marc Bosiers, Jeroen Hendriks, Frank Vermassen, Min Lee, Tom Forbes, Oren Steinmetz, Yvan Douville, Leonard Tse, Wei Guo, Jichun Zhao, Jianfang Luo, Jaime Camacho, Jiri Novotny, Dominique Midy, Jean-Pierre Becquemin, Emmanuel Choukroun, Dittmar Bockler, G Torsello, Gerhard Hoffmann, Kostantinos Papazoglou, Dimitris Kiskinis, Stephen Cheng, Yehuda Wolf, Andrea Stella, Carlo Pratesi, Carlo Setacci, Jae Kyu Kim, Do Yun Lee, Valdas Bilkis, Steven van Sterkenburg, Joep Teijink, Rob Welten, Jean-Paul de Vries, Hence Verhagen, Jan Heijligers, Andrew Hill, Thodur Vasudevan, Guttorm Jenssen, Eric Dorenberg, Rolf Busund, Piotr Gutowski, Walerian Staszkiewicz, Joao Albuquerque e Castro, Ivan Vulev, Phillip Matley, Corstiaan Leendert Punt, Jacobus Van Marle, V Riambau, Eduardo Ros, Aurelio Garcia de la Torre, Francisco Gomez Palons, Carlos Vaquero Puerta, Hakan Roos, Thomas Larzon, Martin Delle, Do Dai-Do, Juerg Schmidli, Boonprasit Kritpracha, Furuzan Numan, Yigit Goktay, Levent Oguzkurt, Paul Hayes, Richard McWilliams, Matt Thompson, Ray Ashleigh, John Rose, Carmelo Gastambide
Abstract
Objective: Greater flexibility and smaller sizes for introducer sheaths in the newest stent grafts increase the feasibility of endovascular aneurysm repair but raise concerns about long-term limb patency. The aim of the study was to determine the incidence of and predictive factors for limb occlusion after use of the Endurant stent graft (Medtronic Inc, Minneapolis, Minn) for abdominal aortic aneurysm.
Methods: The Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) prospectively included 1143 patients treated with bifurcated devices who were observed for up to 2 years. Limb occlusions were evidenced by computed tomography, angiography, or ultrasound. To predict stent graft limb occlusion, a two-step model-building technique was applied. We first identified predictors from a total of 47 covariates obtained at baseline and in the periprocedural period. Subsequently, we reduced the set of potential predictors to key factors that are clinically meaningful. To handle large numbers of covariates, we used the Classification And Regression Tree (CART) method.
Results: Forty-two stent graft limbs occluded in 39 patients (3.4% of the patients). At 2 years, the rate of freedom from stent graft limb occlusion calculated by Kaplan-Meier plot was 97.9% (standard error [SE], 0.33%). Of the 42 occlusions, 13 (31%) were observed within 30 days and 30 (71%) within 6 months. The strongest independent predictors were distal landing zone on the external iliac artery, external iliac artery diameter ≤10 mm, and kinking. High-risk vs low-risk patients were identified according to a decision tree based on the strongest predictors. Freedom from stent graft limb occlusion was 96.1% (SE, 0.64%) in high-risk patients vs 99.6% (SE, 0.19%) in low-risk patients.
Conclusions: After Endurant stent grafting, the incidence of limb occlusion was low. Classifying patients as high risk vs low risk according to the algorithm used in this study may help define specific strategies to prevent limb occlusion and improve the overall results of endovascular aneurysm repair using the latest generation of stent grafts.
Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
Source: PubMed