Research article summary (published 14 Jul 2009):

A comparison of the mid-term results following the use of bifurcated and aorto-uni-iliac devices in the treatment of abdominal aortic aneurysms.

Full Abstract

PURPOSE: To compare the mid-term results following the use of bifurcated (ABIS) and aorto-uniiliac (AUIS) endovascular devices in the treatment of abdominal aortic aneurysms (AAA) in a population of patients deemed to be at high risk for open surgery. MATERIAL AND METHODS: Over a 4 year period (January 2003 to December 2007), 447 underwent elective endovascular aneurysm repair (EVAR) using ZENITH) stent-grafts. Group I comprised patients treated using the AUIS (n=124), and group II those receiving ABIS (n=323). Outcome measures included the assisted technical success rate, perioperative mortality, major complications, freedom from reintervention, and primary and secondary patencies. Factors associated with mid-term clinical failures were determined using univariate and multivariate analyses. RESULTS: The assisted primary technical success rate was 94% and 99% in groups I and II respectively (p=.002). Major perioperative complications occurred in 13 group I patients (10%) vs. 12 group II patients (4%) (p=.005). The 30-day mortality rate was 3.2% vs.1.5% (p=0.2). TASC C and D iliac lesions significantly increased the risk of major perioperative complications (35% vs. 3%; OR=14.94; 95% CI: 5.75 to 38.78; p<.0001). During the follow-up period (median 24 months), secondary procedures were required in 11% and 5% of group I and group II patients respectively (p=.01). Freedom from reintervention at 12, 24 and 36 months was 98%, 90%, and 85% in group I vs. 96%, 92%, and 92% in group II (P<0.005). The primary and secondary patency rates at 3 years were 92% vs. 98% (p=.003) and 97% vs. 99% (p=.04) for groups I and II respectively. In group I, the Crossover Femoro-Femoral Bypass (CFFB) was responsible for 3 major complications (2.4%) which occurred at 7, 12 and 57 months of follow-up. However, the use of AUIS with CFFB did not independently increase the risk of major complications during follow-up (HR=0.108; 95% CI: 0.007 to 1.637; p=.11, Cox proportion model). In both univariate and multivariate analysis, concomitant iliac arterial occlusive disease (IAOD) was the only significant predictor of clinical failure in study population as a whole (OR=3.996; 95% CI: 1.996 to 7.921; p<.0001). CONCLUSION: This study demonstrates that ABIS is associated with better results than AUIS in the management of patients with AAA. Iliac artery occlusive disease was more frequently diagnosed in the AUIS group and this was significantly associated with a higher risk of complications, while the crossover graft itself was not. Nevertheless, the outcomes for both groups are encouraging in this high risk population.

Author information

Author/s: Jean-Baptiste, E (E); Batt, M (M); Azzaoui, R (R); Koussa, M (M); Hassen-Khodja, R (R); Haulon, S (S);

Affiliation: Department of Vascular Surgery, Hôpital Saint-Roch du CHU de Nice, Université de Nice Sophia-Antipolis. Nice, France.

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study

Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg), published in England. (Language: eng)

Reference: 2009-Sep; vol 38 (issue 3) : pp 298-304

Dates: Created 2009/08/14; Completed 2009/08/27;

PMID: 19608439, status: MEDLINE (last retrieval date: 8/27/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged Aged, 80 and over Aortic Aneurysm, Abdominal - complications; mortality; surgery Arterial Occlusive Diseases - complications; mortality; surgery Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects; instrumentation; mortality Female France - epidemiology Humans Iliac Artery - surgery Kaplan-Meiers Estimate Male

Male Middle Aged Odds Ratio Proportional Hazards Models Prosthesis Design Reoperation Retrospective Studies Risk Assessment Risk Factors Stents Time Factors Treatment Outcome

Related articles

These are the highest related articles currently in the database:

• Minimally invasive retrieval of a dislodged Wallstent endoprosthesis after an endovascular abdominal aortic aneurysm repair. 30 Jan 2008
• A double bifurcated graft for abdominal aorta and bilateral iliac artery reconstruction. 30 Dec 1998
• Anatomic suitability of ruptured abdominal aortic aneurysms for endovascular repair. 24 Jul 2008
• Infrarenal aortofemoral bypass surgery: risk factors and mortality in 330 patients with abdominal aortic aneurysm or aortoiliac occlusive disease. 30 Dec 1995
• Impact of the introduction of endovascular aneurysm repair in high-risk patients on our practice of elective treatment of infrarenal abdominal aortic aneurysms. 17 Sep 2008
• Long-term surveillance is paramount after implantation of the Vanguard stent-graft for abdominal aortic aneurysms. 30 Jan 2008
• EVAR in iliac occlusion. 30 Jan 2007
• Lifeline registry of endovascular aneurysm repair: open repair surgical controls in clinical trials. 21 Jul 2008
• A modular aortouniiliac endovascular stent-graft is a useful device for the treatment of symptomatic and ruptured infrarenal abdominal aortic aneurysms: one-year results from a multicentre study. 8 Jul 2007
• Abdominal aortic aneurysm and lower-limb occlusive arterial disease. 30 Mar 1998

See 100+ related articles.

Related Article Map

Legend: - FREE Full text Article. - Abstract only. - Title only. More help.

See a large map of 100+ related articles.