11:24 AM Abstract No. 209 Combined Endovascular and Open Repair for Aorto- Enteric Fistulas. G. Piffaretti 1 , G. Carrafiello 2 , T. Porretta 1 , P. Castelli 1 ; 1 University of Insubria - Department of Surgical Sciences - Vascular Surgery, Varese, Italy; 2 University of Insubria - Department of Radiology - Interventional Radiology, Var- ese, Italy. PURPOSE: Aorto-enteric fistulas are a rare complication after aortic surgery with operative repair historically asso- ciated with extremely high morbidity and mortality. We reviewed our experience of endovascular treatment of aorto- enteric fistulas. MATERIALS & METHODS: Through a 6-years period, 6 patients were treated for aorto-enteric fistula by endovascu- lar repair. Five were male. The mean age was 76 years. All patients had had previous aortic or aorto-iliac reconstructive surgery, 5-36 months before. All patients showed clinical or biochemical signs of bleeding. Four (67%) were in shock, 2 (33%) had systemic signs of infection; all patients were treated in an emergency setting. Endograft used were: aortic cuff (n=3), bifurcated graft (n=2), and an aorto-uni-iliac graft (n=1); fistulas were located in the duodenum (n=3), and in the ileus (n=3). All but one patient underwent excision of the fistula. All patients received a multiple association of antibiotics postoperatively for a prolonged period of time. RESULTS: All aorto-enteric fistulas were successfully sealed. Two patients died: cause of death were sepsis (n=1), and myocardial infarction (n=1). Every patient required intensive care unit stay for a mean 6 days (range, 1-12); mean hospital stay was 23 (range, 16-29) days. No patient died during the follow-up period (mean 8 months; range, 4-24). Re-infection occurred in 1 ) patient after 4 months when underwent open excision and an “in-situ” silver bonded graft reconstuction. Four patients (67%) are still alive and well with no clinical or radiologic evidence of recurrent bleeding or infection. CONCLUSION: Endovascular sealing of aorto-enteric fis- tula is an attractive alternative technique to conventional repair, which provides time especially useful to treat shock and a better situation to perform excision of the fistulas. Danger of re-infection remains high. 11:36 AM Abstract No. 210 Outcomes of EVAR in Patients with Conical Necks. T.J. Ryan, B. Arslan, U.C. Turba, S.S. Sabri, A.H. Matsumoto, J.F. Angle; University of Virginia Health System, Charlottesville, VA. PURPOSE: To evaluate safety and effectiveness of endo- vascular repair of abdominal aortic aneurysms (EVAR) with conical necks. MATERIALS & METHODS: A retrospective review of our database yielded 96 cases of EVAR between Aug 05 and Aug 07. Of these, 90 had preoperative thin slice CT angio- grams available to evaluate infrarenal neck morphology. Using the centerline vessel analysis function on our PACS, we measured the major and minor axes at the level of the lowest preserved renal artery and 15mm inferiorly. We labeled any neck as “conical” which increased in diameter more than 10% over 15mm distance. We identified cases with type 1a endoleaks on angiography after stent graft deployment and primary balloon molding, and additional interventions required to seal the endoleaks and success or failure thereof. The incidence of late type 1a endoleaks was determined by reviewing the most recent CT imaging. We determined the proportion of conical necks among EVAR cases as well as the periprocedural and persistent type Ia endoleaks, and adjunctive intervention attempts to treat these endoleaks. Fisher’s exact T test and Chi-square anal- yses were performed to compare type Ia endoleak incidence in conical and straight necks. RESULTS: Conical necks were found in 33 of 96 patients. 5 out of 33 (15%) cases with conical necks and 6 out of 63 (9.5%) cases with straight necks had type Ia endoleaks. P=NS. Vigourous attempts to treat all type Ia endoleaks were made by balloon molding, balloon expandable stent placement and/or cuff extension. Conical neck type Ia en- doleaks were treated on the table successfully in 2 of 5 cases. Three type Ia endoleaks persisted. One resolved at follow up, one patient died at 13 months and one patient was lost to follow up. Straight neck type Ia endoleaks were treated on the table in 2 of 6 cases. Persistent type Ia endoleaks in 4 of 6 straight necks resolved on follow up CTA (mean follow up 15 months). CONCLUSION: Our study shows conical aneurysmal neck morphology to have a higher tendency for type 1a endoleak but this difference is not statistically significant. Select patients who are considered high risk for surgery with conical aneurysm neck morphology can be considered for EVAR. 11:48 AM Abstract No. 211 FEATURED ABSTRACT Secondary Intervention Rates Following Endoluminal Infrarenal Aortic Aneurysm Repair. K. Katsanos 1 , S. Black 2 , F. Ahmad 1 , H. Zayed 2 , R. Salter 1 , C. Sandhu 1 , S. Thomas 1 , J. Reidy 1 , P.R. Taylor 2 , T. Sabharwal 1 ; 1 Guy’s and St. Thomas’ Hospitals - Inter- ventional Radiology, London, United Kingdom; 2 Guy’s and St. Thomas’ Hospitals - Vascular Surgery, London, United Kingdom. PURPOSE: The assumption exists that endoluminal aneu- rysm repair has a higher rate of secondary interventions compared to open surgery. This has led to an unchallenged requirement for long-term interval surveillance and con- cerns over long-term cost-effectiveness. We examine our experience of over 400 procedures to assess the validity of these assumptions. MATERIALS & METHODS: Prospective data was collected on 453 consecutive patients undergoing endograft repair with a Zenith AAA device (William Cook, Europe) between April 2000 and January 2008. The rate of secondary inter- ventions, associated morbidity and whether the need for re-intervention could be predicted by surveillance imaging was analysed. RESULTS: 406 (89.8%) patients underwent elective repair, 17 (3.6%) as urgent cases and 30 (6.6%) as emergencies (true rupture).The male:female ratio was 11:1 with a median age of 76 (range, 40-93 years). 2 cases had to be converted to open repair (one emergency, one urgent). The overall 30-day mortality rate was 3.3% (15/453). Secondary inter- ventions were performed in 33/453 (7.2%) patients of which only 6/453 (1.3%) were detected during routine surveil- lance. Endoleaks requiring re-intervention were noted in Scientific Sessions WEDNESDAY S81