Long-term outcomes of endovascular aneurysm repair in standard versus narrow aortic bifurcation.

Abstract

The purpose of this study was to evaluate the long-term outcomes after endovascular aortic aneurysm repair using a bifurcated device in patients with standard aortic bifurcation (SB) and narrow aortic bifurcation (NB). Data were obtained from 1870 patients who had data prospectively collected in the multicenter Global Registry for Endovascular Aortic Treatment (GREAT). There were 183 patients (9.8%) with NB (defined as <16 mm) and 1687 patients with SB treated with a bifurcated device for abdominal aortic aneurysms. Periprocedural success and long-term clinical outcomes were analyzed. The mean distal aortic diameter was 12.7 mm for NB patients and 25.2 mm for SB patients. The NB cohort had more females (21.3% vs 14.8%) and had a greater prevalence of medical comorbidities (hypertension, hypercholesterolemia, peripheral arterial disease, and carotid disease). The NB patients also had a smaller maximum proximal aortic neck (22.2 mm vs 24.2 mm), smaller maximum aortic size (54.5 mm vs 56.5 mm), and smaller access vessel diameter (7.7 mm vs 8.5 mm). Surgical cutdown for arterial access was more common (66% vs 50%) in the NB patients. At 1 month, there were low rates (0.4% NB vs 1.0% SB) of any type I or III endoleaks. The 2-year all-cause mortality rates (13.1% NB vs 14.2% SB) and all reintervention rates (9.3% NB vs 7.1% SB) were similar. On long-term follow-up (6 years), there remained no statistically significant difference in the all-cause mortality (32.2% NB vs 34.0% SB) and all reintervention rates (25.0% NB vs 21.2% SB). There were no instances of fracture or compression. Patients with NB were more likely to be female with a smaller aortic neck and access vessels with a greater prevalence of comorbid conditions. Despite these differences, there were similar rates of long-term complications. The presence of NB does not affect long-term outcomes of endovascular aortic aneurysm repair.