Print this pageEndovascular Aneurysm Repair at Five Years: Does Size Matter?
Back to Annual Meeting
Back to Program
Christopher K. Zarins, MD1, Daniel A. Bloch, PhD1, Tami Crabtree1, Frank R. Arko, MD2, Kenneth Ouriel, MD3, Rodney A. White, MD4.
1Stanford University, Stanford, CA, USA, 2UT Southwestern, Dallas, VA, USA, 3Cleveland Clinic, Cleveland, OH, USA, 4Harbor UCLA, Torrence, CA, USA.
BACKGROUND: The appropriateness of and long-term outcome of treating patients with small aneurysms with endovascular repair (EVAR) is unclear. We sought to determine whether pre-op AAA size is a significant factor in the long term outcome of EVAR
METHODS: We reviewed the 5 year results of 923 patients in a prospective, multicenter clinical trial of EVAR. Patients with small (4.0-4.9 cm, n=145), medium (5.0-5.9 cm, n=461) and large (>6.0 cm, n=317) aneurysms were compared at baseline and over 5 years. Kaplan-Meier estimates were calculated for the primary outcome measures which included freedom from rupture, AAA related death, surgical conversion, secondary intervention and over-all survival. Rates of endoleaks, migration and aneurysm enlargement were also compared.
RESULTS: Patients with small AAA were youngest (71 vs. 73 vs. 75 years, p<0.0001) and were more likely to have a family history of AAA (p<0.05), coronary intervention (p=0.003) and PVD (p=0.008) and least likely to have COPD (p=0.005), CHF (p=0.004) and obesity (p=0.03). Small AAA patients were also better operative risks with the lowest ASA grades (p=0.01) and had the most favorable anatomy with the smallest diameter necks (21 vs. vs. 22 vs. 23 mm, p<0.0001) and the longest necks (30 vs. 28 vs. 27mm, p=0.004). Freedom from rupture at 5 years was 100% for small, 96% for medium and 91% for large AAA (p<0.05). Freedom from AAA-death at 5 years was 99% for small, 97% for medium and 90% for large AAA (p<0.05). Freedom from conversion at 5 years was 98% in small, 89% in medium and 87% in large AAA (p<0.05). Survival at 5 years was 73% in small, 64% in medium and 52% in large AAA (p<0.05). There were no differences in secondary intervention, endoleak, migration or aneurysm enlargement rates between small, medium and large aneurysms.
CONCLUSIONS: Aneurysm size matters in the long-term outcome of EVAR. Patients with small aneurysms are the best candidates and have the best long-term outcomes.
Read the Privacy Policy.