Twenty years outcomes in a single center experience after endovascular aneurysm repair with unibody endograft and anatomical fixation

BaCKground: To assess the long-term safety and effectiveness of endovascular aneurysm repair (evar) treatment with unibody endograft deployed on aortic bifurcation (anatomical fixation). MeThods: a retrospective, observational, single-center study of patients treated from 1999 to 2002 with unibody bifurcated endograft. follow-up protocol required clinical and doppler-ultrasound at 1 and 6 months and annually thereafter, computed tomography angiography at 1-, 6- and 12-months and then every year. Primary endpoints included technical and treatment success, survival and freedom from late evar failure; secondary endpoints were freedom from late open conversion (loC), freedom from late re-interventions and endoleaks. resulTs: seventy-three patients, mean age of 73±6 years were enrolled. Median follow-up was 6±0.5 years. Technical success was 98.6% (n.=71/73; causes of failure: 1 open conversion and 1 type ib endoleak). a treatment success of 96% (n.=69/72) was recorded due to endoleaks (n.=2; 1 type ia and 1 type ib) and limb occlusion (n.=1). survival at 1, 5, 10, 15 and 18 years was 90%, 58%, 40%, 32% and 23% respectively. one aneurysm-related death for infection of the endograft was registered. evar failure was 14% (n.=10/71). Three loC were recorded and freedom from reinterventions at 1, 5, 10 and 18 years was 99%, 91%, 86% and 86%. fourteen endoleaks were recorded: ia (n.=6; 42.8%), ia+ib (n.=1; 7.1%), ib (n.=2; 14.2%) and ii (n.=5; 35.6%). four endoleaks were observed, 9 endovascular correction and 1 loC were required. endoleaks free survival of 90% at 1-year and 75% at the end of the study. aneurysm sac shrinkage was observed in 79% (n.=56/71). CONCLUSIONS: This small, retrospective cohort of anatomically fixed EVAR demonstrated long-term safety and effectiveness. The design of the unibody graft did not substantially change and newer generation should guarantee the same performance.