National Numbers of Secondary Aortic Reinterventions after Primary Abdominal Aortic Aneurysm Surgery from the Dutch Surgical Aneurysm Audit

National Numbers of Secondary Aortic Reinterventions after Primary Abdominal Aortic Aneurysm Surgery from the Dutch Surgical Aneurysm Audit

Long-term secondary aortic reinterventions (SARs) can be a sign of (lack of) effectiveness of abdominal aortic aneurysm (AAA) surgery. This study provides insight into the national number of SARs after primary AAA repair by endovascular aneurysm repair (EVAR) or by open surgical repair in the Nether...

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Published in:Annals of vascular surgery 2020-10, Vol.68, p.234-244
Main Authors: Karthaus, Eleonora G., Vahl, Anco, de Borst, Gert J., Hamming, Jaap F., Akkersdijk, G.J., Balm, R., Botman, J.M., Brehm, V., Brummel, P., van Brussel, J.P., Buijs, M.A., Cancrinus, E., Castenmiller, P.H., Daemen, J.H., Dawson, I., Dijkstra, M.L., Dirven, M., Elsman, B.H., van der Elst, A., Fung Kon Jin, P.H., van Gent, W.B., Groenendijk, R.P., Hamming, J.F., Hedeman Joosten, P.P., Helleman, J.N., Ho, G.H., den Hoed, P.T., Hoksbergen, A.W., Hommes, M., Idu, M.M., Jansbeken, J.R., Jiang, H.H., Jongkind, V., Kapma, M.R., Kolkert, J.L., Koning, G.G., Konings, R., Kruse, R.R., van der Laan, M.J., Lardenoye, J.H., Lauret, G.J., Leenders, B.J., Lind, R.C., Loos, M.J., Loubert, M.C., Mahmoud, D.E., Manshanden, C.G., Mattens, E.C., von Meijenfeldt, G.C., Menting, T.P., Minnee, R.C., van de Mortel, R.H., Nevenzel-Putters, A.M., Nieuwenhuis, D.H., van Nieuwenhuizen, R.C., Nio, D., Oomen, A.P., Palamba, H.W., Peppelenbosch, A.G., Ploeg, A.J., Ponfoort, E.D., ten Raa, S., Raymakers, J.T., Reijnen, M.M., van Rijn, M.J., de Roo, R.A., van Sambeek, M.R., van Schaik, J., van Schaik, P.M., Scharn, D.M., Scholtes, V.P., Schreve, M.A., Sikkink, C.J., Smeets, L., Smit, P.C., Snoeijs, M.G., Speijers, M.J., van der Steenhoven, T.J., van Sterkenburg, S.M., Stigter, D.A., Stokmans, R.A., Sybrandy, J.E., Teijink, J.A., Telgenkamp, B.J., Tha-In, T., The, R.M., Thijsse, W.J., Truijers, M., Tutein Nolthenius, R.P., van der Vliet, J.A., Vos, C.G., Vos, G.A., Voute, M.T., de Vries, A.C., de Vries, M., van de Water, W., Welten, G.M., Wouda, R., Yazar, O., Yeung, K.K.
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Language:eng
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Summary:Long-term secondary aortic reinterventions (SARs) can be a sign of (lack of) effectiveness of abdominal aortic aneurysm (AAA) surgery. This study provides insight into the national number of SARs after primary AAA repair by endovascular aneurysm repair (EVAR) or by open surgical repair in the Netherlands. Observational study included all patients undergoing SAR between 2016 and 2017, registered in the compulsory Dutch Surgical Aneurysm Audit (DSAA). The DSAA started in 2013, SARs are registered from 2016. Characteristics of SAR and postoperative outcomes (mortality/complications) were analyzed, stratified by urgency of SAR. Data of SARs were merged with data of their preceded primary AAA repair, registered in the DSAA after January 2013. In these patients undergoing SAR, treatment characteristics of the preceded primary AAA repair were additionally described, with focus on differences between stent grafts. Between 2016 and 2017, 691 patients underwent SAR, this concerned 9.3% of all AAA procedures (infrarenal/juxtarenal/suprarenal) in the Netherlands (77% elective/11% acute symptomatic/12% ruptured). Endoleak (60%) was the most frequent indication for SAR. SARs were performed with EVAR in 66%. Postoperative mortalities after SAR were 3.4%, 11%, and 29% in elective, acute symptomatic, and ruptured patients, respectively. In 26% (n = 181) of the patients undergoing SAR their primary AAA repair was performed after January 2013 and data of primary and SAR procedures could be merged. In 93% (n = 136), primary AAA repair was EVAR. Endografts primarily used were nitinol/polyester (62%), nitinol/polytetrafluoroethylene (8%), endovascular sealing (21%), and others (9%), compared with their national market share of 76% (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.38–0.71), 15% (OR, 0.50; CI, 0.29–0.89), 4.9% (OR, 5.04; CI, 3.44–7.38), and 4.1% (OR, 2.81; CI, 1.66–4.74), respectively. In the Netherlands, about one-tenth of the annual AAA procedures concerns an SAR. A quarter of this cohort had an SAR within 1–5 years after their primary AAA repair. Most SARs followed after primary EVAR procedures, in which an overrepresentation of endovascular sealing grafts was seen. Postoperative mortality after SAR is comparable with primary AAA repair.
ISSN:0890-5096
1615-5947