Endovascular Repair of Abdominal Aortic Aneurysms Mayo Clin Proc, October 2003, Vol 78 1234 Mayo Clin Proc. 2003;78:1234-1242 1234 © 2003 Mayo Foundation for Medical Education and Research Original Article Endovascular Repair of Abdominal Aortic Aneurysms: Initial Experience With 100 Consecutive Patients STEPHANE ELKOURI, MD; PETER GLOVICZKI, MD; MICHAEL A. MCKUSICK, MD; JEAN M. PANNETON, MD; JAMES C. ANDREWS, MD; THOMAS C. BOWER, MD; AUDRA A. NOEL, MD; TIMOTHY M. SULLIVAN, MD; LINDA G. CANTON, RN, BSN, CVN; WILLIAM S. HARMSEN, MS; TANYA L. HOSKIN, MS; AND KENNETH J. CHERRY, MD From the Division of Vascular Surgery (S.E., P.G., M.A.M., J.M.P., J.C.A., T.C.B., A.A.N., T.M.S., L.G.C., K.J.C.), Department of Radiol- ogy (M.A.M., J.C.A.), and Division of Biostatistics (W.S.H., T.L.H.), Mayo Clinic, Rochester, Minn. Dr Elkouri is now with the Hôtel Dieu de Montreal, Centre Hospitalier de l’Université de Montreal, Mon- treal, Quebec. Address reprint requests and correspondence to Peter Gloviczki, MD, Division of Vascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: gloviczki.peter@mayo.edu). • Objective: To review early results of endovascular re- pair of abdominal aortic aneurysms (AAAs). • Patients and Methods: The first 100 patients who un- derwent endovascular repair of AAA (EVAR) between June 26, 1996, and October 31, 2001, at the Mayo Clinic in Rochester, Minn, were studied retrospectively to evaluate technical success, freedom from reinterventions, and early clinical outcome. • Results: A total of 89 men and 11 women (mean ± SD age, 76± 7 years; range, 47-92 years) underwent EVAR. The procedure was successful in 97 patients. There was no early death. Major complications occurred in 25 patients. The 30-day technical success rate was 86% (95% confi- dence interval [CI], 77%-92%). The median intensive care unit stay was 1 day (range, 1-15 days), and the median hospital stay was 3 days (range, 1-35 days). Median follow- up was 7 months (range, 1-60 months). Endoleak (incom- plete seal of the endovascular graft) at discharge was ob- served in 14 patients; 13 developed endoleak during fol- low-up. There were 23 reinterventions, 65% of which were percutaneous procedures. One aneurysm ruptured at 5 months, but the patient was successfully treated by open repair. Primary and secondary graft patency rates at 1 year were 83% (95% CI, 74%-93%) and 94% (95% CI, 87%-99%), respectively. The freedom from reintervention rate at 1 year was 71% (95% CI, 59%-84%), with an overall success rate from EVAR of 92% (95% CI, 84%- 100%). There were no differences in early patency, reinterventions, and success rates between unibody and modular devices. • Conclusion: EVAR can be performed with high tech- nical success and low mortality rates; however, nonfatal complications and catheter-based reinterventions are fre- quent, and EVAR may not prevent aneurysm rupture. Although stent graft repair for high-risk patients is ap- pealing, current data are insufficient to support EVAR as the preferred treatment of AAAs. Mayo Clin Proc. 2003;78:1234-1242 E ndovascular repair of abdominal aortic aneurysm (EVAR) with stent grafts has been used in recent years with increasing frequency to decrease morbidity of con- ventional surgical treatment. EVAR was introduced in 1991 by Parodi et al. 1 Clinical trials in Europe, 2-5 Austra- lia, 6,7 and the United States 8-18 showed early technical suc- cess and low mortality of endovascular repair. Two stent grafts, the AneuRx (Medtronic AVE, Santa Rosa, Calif) and the EndoVascular Technology (EVT)/ANCURE (Guidant Corp, Menlo Park, Calif), were approved for EVAR in September 1999 by the US Food and Drug Ad- ministration (FDA). Early enthusiasm was followed by AAA = abdominal aortic aneurysm; CI = confidence interval; CT = computed tomography; EVAR = endovascular repair of AAA; EVT = EndoVascular Technology; FDA = Food and Drug Administration; ICU = intensive care unit reports of device failure, migration, and aneurysm rupture after EVAR. 19-28 An article from the British Journal of Sur- gery 29 even questioned the value of this procedure, calling it a failed experiment. However, most vascular interven- tionists continue to use EVAR but do so selectively and with emphasis on rigorous follow-up. 30 The first successful EVAR was performed at the Mayo Clinic in Rochester, Minn, on June 26, 1996. Since FDA approval of the AneuRx and EVT/ANCURE devices, the number of these procedures has increased at our institu- tion, and in 2002, 37% of all abdominal aortic aneurysms (AAAs) were repaired with stent grafts. The goal of this study was to evaluate early results with EVAR in the first 100 patients and to determine technical success, freedom from reinterventions, and early clinical outcome. PATIENTS AND M ETHODS Data Collection We retrospectively reviewed clinical data from the first 100 patients who underwent EVAR between June 26, For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.