Reintervention following endovascular abdominal aneurysm repair is uncommon after five-years: results of greater than a decade follow-up.

Background: Endovascular aneurysm repair offers improved perioperative morbidity and mortality compared to open repair, counterbalanced by a higher incidence of graft-related complications and re-interventions. Randomized studies comparing EVAR to open repair are yet to report greater than ten-year outcomes. This study reports the outcomes of patients who underwent EVAR greater than ten years ago.

Methods: Retrospective review of prospectively collected data of all patients who underwent EVAR between 1997 and 2001, supplemented with case-note review, interrogation of imaging and correspondence with general practitioners and coroners' offices.

Results: Fifty-eight patients underwent EVAR. Technical success was 100% and 30-day mortality was 0%. The re-intervention rate was 27.3%, including 5 elective open conversions, 2 emergency open repairs, 5 embolizations of endoleaks and 3 extensions. Median time to primary re-intervention was 30 months (1-98). Four graft related complications occurred beyond 5 years however only one reintervention was performed beyond this time point. Four patients died from ruptured AAA.

Conclusions: Stable long-term aneurysm exclusion was achieved in the majority of patients with most re-interventions occurring early in the follow up period. Whilst life-long surveillance should be continued, these data raise the question of the appropriate duration of CT surveillance and suggest that EVAR should be considered for patients with longer life expectancy and favourable anatomy who traditionally would have undergone open repair.