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Accarino G, De Vuono F, Accarino G, Fornino G, Puca AE, Fimiani R, Parrella V, Savarese G, Furgiuele S, Vecchione C, Galasso G, Bracale UM. Endurant Stent Graft for Treatment of Abdominal Aortic Aneurysm Inside and Outside of the Instructions for Use for the Proximal Neck: A 14-Year, Single-Center Experience. J Clin Med 2024; 13:2589. [PMID: 38731118 PMCID: PMC11084245 DOI: 10.3390/jcm13092589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Aim: To assess the medium and long-term performance of the Endurant stent graft in a cohort of consecutive patients treated with this device for an abdominal aortic aneurysm (AAA) both inside and outside of the instructions for use (IFU) and to find factors influencing the outcomes. Methods: Our observational, retrospective, single-center study included all patients who consecutively underwent endovascular aneurysm repair with the Endurant stent graft from February 2009 to January 2023. Patients with an AAA to treat according to current guidelines were included. Patients were divided into two groups: Group 1 inside of the IFUs and Group 2 outside of the IFUs for the proximal aortic neck. Patients were followed up after the procedure with computed angiography tomography, ultrasound examination, and interviews. Aneurysm-related mortality, procedure-related reinterventions, and type IA and III endoleaks were considered primary endpoints. Secondary endpoints included aneurysmal sac variations and graft thrombosis. Results: A total of 795 patients were included, 650 in Group 1 and 145 in Group 2; 732 were males, and the mean age was 74 ± 8. Anamnestic baseline did not differ between the two groups. Neck length, width, and angulation were different between the two groups (all p < 0.001). A total of 40 patients had a ruptured AAA, while 56 were symptomatic. At a mean follow-up of 43 ± 39 months, aneurysm-related mortality was less than 1%, and 82 endoleak (10.5%) were observed. Overall endoleak rate and type 1A endoleak, as well as procedure-related reintervention, were significantly more frequent in Group 2. Sac regression of at least 5 mm was observed in 65.9% of cases. AAAs larger than 60.5 mm carried a higher risk of endoleak (HR: 1.025; 95% CI: 1.013-1.37; p < 0.001) and proximal necks shorter than 13.5 mm carried a higher type 1A risk (HR: 0.890; 95% CI: 0.836-0.948; p < 0.001). Patients without chronic obstructive pulmonary disease and taking lipid-lowering drugs had an overall more consistent sac-shrinking rate. Conclusions: The Endurant stent graft proves safe and reliable. Out-of-IFU treatment has poorer medium and long-term outcomes. Some conditions influence medium and long-term reintervention risk and sac behavior. Patients with bigger aneurysms, proximal necks shorter than 13.5 mm, and chronic obstructive pulmonary disease should be more carefully evaluated during follow-up. Consistent follow-up is in keeping low aneurysm-related mortality. Personalized risk profiles and peri and postoperative management strategies are needed.
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Affiliation(s)
- Giulio Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (G.S.); (U.M.B.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Francesco De Vuono
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Giancarlo Accarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Giovanni Fornino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
| | - Aniello Enrico Puca
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
| | - Rodolfo Fimiani
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
| | - Valentina Parrella
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Giovanni Savarese
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (G.S.); (U.M.B.)
| | - Sergio Furgiuele
- Vascular Surgery Unit, Struttura Ospedaliera ad Alta Specialità Mediterranea, 80122 Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Umberto Marcello Bracale
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (G.S.); (U.M.B.)
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Zhang L, Wei J, Wei J, Zhang Z, Zhang J, Tang Q, Wang Y, Pan Y, Qin X. Identification of Clinical Heterogeneity and Construction of Prediction Models for Novel Subtypes in Patients with Abdominal Aortic Aneurysm: An Unsupervised Machine Learning Study. Ann Vasc Surg 2024; 98:75-86. [PMID: 37380047 DOI: 10.1016/j.avsg.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/08/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is one of the most common diseases in vascular surgery. Endovascular aneurysm repair (EVAR) can effectively treat AAA. It is essential to accurately classify patients with AAA who need EVAR. METHODS We enrolled 266 patients with AAA who underwent EVAR. Unsupervised machine learning algorithms (UMLAs) were used to cluster subjects according to similar clinical characteristics. To verify UMLA's accuracy, the operative and postoperative results of the 2 clusters were analyzed. Finally, a prediction model was developed using binary logistic regression analysis. RESULTS UMLAs could correctly classify patients based on their clinical characteristics. Patients in Cluster 1 were older, had a higher BMI, and were more likely than patients in Cluster 2 to develop pneumonia, chronic obstructive pulmonary disease, and cerebrovascular disease. The aneurysm diameter, neck angulation, diameter and angulation of bilateral common iliac arteries, and incidence of iliac artery aneurysm were significantly higher in cluster 1 patients than in cluster 2. Cluster 1 had a longer operative time, a longer length of stay in the intensive care unit and hospital, a higher medical expense, and a higher incidence of reintervention. A nomogram was established based on the BMI, neck angulation, left common iliac artery (LCIA) diameter and angulation, and right common iliac artery (RCIA) diameter and angulation. The nomogram was evaluated using receiver operating characteristic curve analysis, with an area under the curve of 0.933 (95% confidence interval, 0.902-0.963) and a C-index of 0.927. CONCLUSIONS Our findings demonstrate that UMLAs can be used to rationally classify a heterogeneous cohort of patients with AAA effectively, and the analysis of postoperative variables also verified the accuracy of UMLAs. We established a prediction model for new subtypes of AAA, which can improve the quality of management of patients with AAA.
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Affiliation(s)
- Lin Zhang
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Jingpeng Wei
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Jindou Wei
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Zhanman Zhang
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Jiangfeng Zhang
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Qianhui Tang
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Yue Wang
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Yicong Pan
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Xiao Qin
- Department of Vascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China.
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Al Tannir AH, Chahrour MA, Chamseddine H, Assi S, Boyajian T, Haddad FF, Hoballah JJ. Outcomes and Cost-Analysis of Open Versus Endovascular Abdominal Aortic Aneurysm Repair in a Developing Country: A 15-year Experience at a Tertiary Medical Center. Ann Vasc Surg 2023; 90:58-66. [PMID: 36309170 DOI: 10.1016/j.avsg.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Endovascular aortic aneurysm repair (EVAR) has become the most common procedure for treating abdominal aortic aneurysms based on multiple studies conducted in the western world. The implication of such findings in developing countries is not well demonstrated. The objective of this study was to compare medical outcomes and costs of EVAR and open surgical repair (OSR) in a developing country. METHODS This is a retrospective study of all patients undergoing elective abdominal aortic aneurysm repair between 2005 and 2020 at a tertiary medical center in a developing country. Medical records were used to retrieve demographics, comorbidities, and perioperative complications. Medical records were also used to provide data on the need of reintervention, date of last follow-up, and mortality. RESULTS The study included a total of 164 patients. Median follow-up time was 41 months. The mean age was 69.9 +/- 7.84 years and 90.24% (n = 148) of patients were males. Regarding long-term mortality outcomes, no significant difference was detected between both groups; OSR patients had a survival rate of 91.38% and 74.86% at 5 and 10 years, compared to 77.29% and 56.52% in the EVAR group (P value = 0.10). Both groups had comparable long-term reintervention rates (P value = 0.334). The OSR group was charged significantly less than the EVAR group ($27,666.35 vs. $44,528.04, P value = 0.008). CONCLUSIONS OSR and EVAR have comparable survival and reintervention outcomes. Unlike what was reported in developed countries, patients undergoing OSR in countries with low hospital stay costs incur lower treatment costs.
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Affiliation(s)
| | - Mohamad A Chahrour
- Division of Vascular Surgery, Department of Surgery, University of Iowa Hospital and Clinics, Iowa, IA
| | | | - Sahar Assi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Talar Boyajian
- Division of Vascular and Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi F Haddad
- Division of Vascular and Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamal J Hoballah
- Division of Vascular and Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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