Abstract | OBJECTIVE: Type I attachment site endoleaks are the most common cause for reintervention after thoracic endovascular aortic repair ( TEVAR) and represent treatment failures. Deployment of endografts in segments of the aorta previously replaced with Dacron grafts may be associated with reduced type I endoleak due to mechanical stability and decreased potential for aortic remodeling. However, no study has rigorously examined endoleak rates in Dacron landing zones vs native aorta. METHODS: A retrospective analysis of a prospectively maintained database was performed to identify all patients undergoing TEVAR at a single referral institution between May 2002 and June 2012. Overall, 319 patients undergoing 345 procedures had at least one follow-up contrast-enhanced computed tomography scan to assess for postoperative type I endoleak. Attachment site landing zones were classified as native aorta, Dacron, or endograft if landed in a previously placed endograft. Patient characteristics and type I endoleak rates were compared among the three groups. RESULTS: Identified were 697 proximal or distal landing zones (native aorta, 599; Dacron, 79; and endograft, 19). Patients with at least one Dacron landing zone had higher rates of hypertension (P < .01), chronic obstructive pulmonary disease (P = .04), and prior aortic surgery (P < .01) and were more likely to have undergone complex hybrid repairs (P < .01). Cumulative type I endoleak rates were equivalent between the three types of landing zone (native aorta, 3.7%; Dacron, 2.5%; endograft, 0%; P = .44). Two type I endoleaks occurred with Dacron landing zones in the first tertile of TEVAR experience and with Dacron landing zone lengths of <2.5 cm. Evaluation of endoleak rates by tertile of experience demonstrated decreased type I endoleak rates in Dacron landing zones between the first and second/third tertiles of experience (13.3% vs 0%, P = .03) after a policy of using >4 to 5 cm (twice the device instructions for use) of Dacron overlap was initiated. CONCLUSIONS: Endograft deployment within long-segment (landing zone length of >4-5 cm) Dacron represents a durable option for aortic repair and was associated with a 0% rate of type I endoleak. In cases of a borderline native aortic landing zone, a hybrid procedure to create an adequate Dacron landing zone may be warranted to decrease the risk of type I endoleak and treatment failure.
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Authors | Asvin M Ganapathi, Nicholas D Andersen, Jennifer M Hanna, Jeffrey G Gaca, Richard L McCann, G Chad Hughes |
Journal | Journal of vascular surgery
(J Vasc Surg)
Vol. 59
Issue 4
Pg. 921-9
(Apr 2014)
ISSN: 1097-6809 [Electronic] United States |
PMID | 24360582
(Publication Type: Comparative Study, Journal Article)
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Copyright | Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Chemical References |
- Polyethylene Terephthalates
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Topics |
- Aged
- Aortic Aneurysm, Thoracic
(diagnosis, surgery)
- Aortography
(methods)
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation
(adverse effects, instrumentation, methods)
- Disease-Free Survival
- Endoleak
(diagnosis, etiology, prevention & control)
- Female
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- North Carolina
- Polyethylene Terephthalates
- Prosthesis Design
- Reoperation
- Retrospective Studies
- Risk Factors
- Time Factors
- Tomography, X-Ray Computed
- Treatment Failure
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