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Outcomes after late explantation of aortic endografts depend on indication for explantation.

Publication ,  Journal Article
Arya, S; Coleman, DM; Knepper, J; Henke, PK; Upchurch, GR; Rectenwald, JE; Criado, E; Eliason, JL; Gallagher, KA
Published in: Ann Vasc Surg
October 2013

BACKGROUND: With the growing prevalence of endovascular repair for abdominal aortic aneurysm (AAA), the number of patients requiring graft explantation is increasing. Therefore, knowledge related to outcomes after explantation may lead to improvement in surgical options. In this study we compare our experience with explantation of aortic endografts, based on indication. METHODS: The medical records of all aortic procedures performed at our center were queried during the period from 2002 to 2012. Relevant data from patients needing explantation of aortic endografts were analyzed using Fisher's exact test, t-test, and Kaplan-Meier analysis. RESULTS: Thirty-nine patients underwent aortic endograft explantation (64.1% men). Mean age was 71.9 years with a mean aneurysm size of 6.8 cm (range 3.5-10.7 cm). Hypertension (97.4%), hyperlipidemia (76.9%), and history of smoking (82%) were the most prevalent risk factors. Mean time to explant was 41.7 months (range 2.2-118.4 months). The primary explant indication was endoleak in 27 (69.2%) and infection in 12 (30.8%) patients. The endoleak group consisted of 13 type I, 8 type II, 1 type III, 4 endotension, 1 rupture, and 4 patients with multiple endoleaks. Seven patients were symptomatic, whereas 2 had ruptured aneurysms. Half of the patients in the infection group required supraceliac clamping for explantation. Operative blood loss (P = 0.08) and need for transfusion (P = 0.005) were significantly higher in the infection group. Thirty-day morbidity was 51.8% for the endoleak group and 83% for the infection group (P = 0.08). There were only 2 deaths in the cohort within 30 days, both in the infection group. Twenty-seven patients were alive at a mean follow-up of 1.9 years (range 0.1-8.4 years). CONCLUSIONS: Endograft explantation is a challenging operation with high morbidity and mortality. Furthermore, patients with an infectious etiology have significantly worse outcomes than those requiring explantation for endoleaks.

Duke Scholars

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

October 2013

Volume

27

Issue

7

Start / End Page

865 / 873

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Stents
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Prosthesis-Related Infections
  • Male
  • Kaplan-Meier Estimate
  • Humans
 

Citation

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Chicago
ICMJE
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Arya, S., Coleman, D. M., Knepper, J., Henke, P. K., Upchurch, G. R., Rectenwald, J. E., … Gallagher, K. A. (2013). Outcomes after late explantation of aortic endografts depend on indication for explantation. Ann Vasc Surg, 27(7), 865–873. https://doi.org/10.1016/j.avsg.2013.03.009
Arya, Shipra, Dawn M. Coleman, Jordan Knepper, Peter K. Henke, Gilbert R. Upchurch, John E. Rectenwald, Enrique Criado, Jonathan L. Eliason, and Katherine A. Gallagher. “Outcomes after late explantation of aortic endografts depend on indication for explantation.Ann Vasc Surg 27, no. 7 (October 2013): 865–73. https://doi.org/10.1016/j.avsg.2013.03.009.
Arya S, Coleman DM, Knepper J, Henke PK, Upchurch GR, Rectenwald JE, et al. Outcomes after late explantation of aortic endografts depend on indication for explantation. Ann Vasc Surg. 2013 Oct;27(7):865–73.
Arya, Shipra, et al. “Outcomes after late explantation of aortic endografts depend on indication for explantation.Ann Vasc Surg, vol. 27, no. 7, Oct. 2013, pp. 865–73. Pubmed, doi:10.1016/j.avsg.2013.03.009.
Arya S, Coleman DM, Knepper J, Henke PK, Upchurch GR, Rectenwald JE, Criado E, Eliason JL, Gallagher KA. Outcomes after late explantation of aortic endografts depend on indication for explantation. Ann Vasc Surg. 2013 Oct;27(7):865–873.
Journal cover image

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

October 2013

Volume

27

Issue

7

Start / End Page

865 / 873

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Stents
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Prosthesis-Related Infections
  • Male
  • Kaplan-Meier Estimate
  • Humans