9th Annual Cardiovascular Fellows' Bootcamp. Hotel Zaza and Houston Methodist Research Institute - Methodist Institute for Technology, Innovation & ...
POSTER SESSION
FRIDAY, JUNE 6
All events held at Hynes Convention Center unless otherwise noted. C8: POSTER SESSION
3:30 – 5:00 p.m. Auditorium, Level 2 (enter through Exhibit Hall C)
At the end of this session participants should be able to: 1. Discuss the methodology, results and conclusions of the research presented in vascular health. 2. Identify new technology for diagnosis and treatment of vascular disease. Moderators: Peter F. Lawrence, MD, UCLA Medical Center, Los Angeles, Calif. Melina R. Kibbe, MD, Northwestern University, Chicago, Ill.
Introduction and Rules
C8a: Aortic Disease (1)
3:30 p.m.
3:30 – 5:00 p.m. uAuditorium, Level 2 (enter through Exhibit Hall C)
Moderator: Christopher J. Abularrage, MD, Johns Hopkins Hospital, Baltimore, Md.
PS2. Type Ia Endoleaks Following Fenestrated and Branched Endografts May Lead to Component Instability and Increased Mortality
3:40 p.m.
Adrian O’Callaghan,1 Tara M. Mastracci,1 Roy K. Greenberg,1 Matthew J. Eagleton,1 Shona Bathurst,1 Yuki Kuramochi,1 James Bena.2 1 Vascular Surgery, Cleveland Clinic, Cleveland, Ohio; 2Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
OBJECTIVES: Fenestrated and branched endografts facilitate sealing in the visceral aorta to extend the landing zone for complex aneurysms. We describe the causes and implications of proximal endoleak in our experience. METHODS: Data on all patients undergoing fenestrated/branched repair were entered into a prospective database. Inclusion criteria necessitated the availability of at least one post-operative contrast CT scan. 3-D imaging was used to characterize morphology and correlated with outcome. Blinded assessors resized the repairs in the endoleak group to assess the change in practice from early repairs to current practice. Outcome measures were mortality and a composite of stent fracture, type III and Ic endoleak, as an indicator of device stability.
Vascular Annual Meeting 2014 • June 5 – 7, 2014 • Boston, Massachusetts
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RESULTS: 969 patients underwent fenestrated/branched repair up to July 2013. Emergency repairs (n=24) and patients without requisite imaging (n=21) were excluded, leaving 924 available for analysis. A type Ia endoleak was identified in 23 patients (2.5%). Landing zone choice was implicated as cause of endoleak development, as sealing in the visceral aorta was associated with endoleak development (52.2% vs. 24.5%, p=.006). Aortic related mortality was higher in the endoleak group, 30% vs. 7%, respectively (p=.001) and they experienced a higher incidence of component instability, 34.8 vs. 9.5% (p=.001). CONCLUSIONS: Fenestrated/branched endovascular repair has a low incidence of sealing zone failure despite the increased complexity. Choice of proximal landing zone may predict occurrence of endoleak. Development of a proximal endoleak seems to destabilize the repair and may lead to increased mortality. AUTHOR DISCLOSURES: S. Bathurst: Nothing to disclose; J. Bena: Nothing to disclose; M.J. Eagleton: Cook Medical, consulting fees or other remuneration (payment); Bolton Medical, consulting fees or other remuneration (payment); R.K. Greenberg: Nothing to disclose; Y. Kuramochi: Nothing to disclose; T.M. Mastracci: Cook Medical, consulting fees or other remuneration (payment); A. O’Callaghan: Nothing to disclose. PS4. Re-Intervention After Abdominal Aortic Aneurysm Repair in the Vascular Study Group of New England (VSGNE)
3:45 p.m.
Christina Feng, Rodney Bensley, Marc Schermerhorn.
Beth Israel Deaconess Medical Center, Boston, Mass.
OBJECTIVES: Endovascular repair (EVAR) has become the primary treatment for AAA but is associated with more late re-interventions compared to open repair. This study compares the outcomes from EVAR and open repair in the VSGNE. METHODS: We reviewed all elective, non-ruptured symptomatic, and ruptured endovascular and open repairs of AAA from 2003-2012. Post-operative re-interventions, morbidity, and mortality were compared at 30-days, 30-day to 1-year, and overall 1-year follow-ups. RESULTS: We identified 3347 EVARs and 2251 open repairs. At 30-days and 1-year, overall re-intervention rates were higher after open repair compared to EVAR (Table). Between 30-days and 1-year, re-interventions were less after elective open repair compared to EVAR (2.6% vs. 3.8%, p=0.03) but were similar after open repair and EVAR for symptomatic (4.5% vs. 4.6%, p=0.97) and ruptured (5.5% vs. 4.3%, p=0.58) AAA. Mortality was lower after elective EVAR compared to open repair at 30 days (1.6% vs. 2.6%, p=0.01) but was similar at 1 year (7.2% vs. 7.3%, p=0.88). CONCLUSIONS: Re-intervention was more common after open repair compared to EVAR across all AAA repair in the perioperative period. Between 30-days to 1-year, EVAR had higher re-intervention rates for elective AAA repair but was similar to open repair for symptomatic and ruptured AAA. AUTHOR DISCLOSURES: R. Bensley: Nothing to disclose; C. Feng: Nothing to disclose; M. Schermerhorn: Nothing to disclose.
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Re-Intervention Rates for All Patients Undergoing EVAR vs. Open AAA Repair Re-Interventions
EVAR (n=3347)
Open (n=2251)
p-value
30-Day Re-Interventions
1.9%
11.5%
