Does Aorto-Iliac Anatomy Affect Endovascular Aortic Aneurysm Repair Durability With The New Generation Endografts?

Introduction: Endovascular aneurysm repair(EVAR) has become the main treatment for abdominal aortic aneurysm(AAA). Anatomical features of the AAA are pivotal in EVAR success. The aim of this study was to evaluate known anatomical features as risk factors for the freedom from reintervention(FFR) taking into account the new-generation endografts. Materials and Methods: This study was a retrospective monocentric study including consecutive patients treated by EVAR from 2012 to 2018 in elective setting. All currently reported anatomic factors including aortic neck and iliac arteries proprieties were examined using the pre-operative AngioCT-imaging. The primary endpoint was to define the anatomical risk factors affecting the FFR. Results: A total of 653 patients treated by standard EVAR were included. The mean age was 75.6±8 years. The mean follow-up was 34±11 months. FFR was 98.4%,97.4%,96% and 87.3% at 6,12,24 and 48 months, respectively. Larger aortic neck diameter was significant risk factor for FFR(P=0.001). Aortic neck severe angulation >60° was correlated to the need for reintervention(P=0.001). Larger aneurysm diameter was associated with higher incidence of reinterventions(P<0.001). Infrarenal aortic length(IRAL) measured as distance between renal artery and aortic bifurcation level, was associated with lower FFR(P=0.002). Similarly, the mean aorto-iliac length(MAIL) measured as the sum of distance between the most distal renal artery and iliac bifurcation in both sides divided by two, resulted a negative factor for FFR (P=0.002). At the multivariate analysis of anatomical features, aortic neck diameter (HR1.18;CI:1.02-1.37,P=0.03) and MAIL (HR1.02;CI:1.01-1.04,P=0.01) were confirmed as significant risk factors for FFR. Conclusion: This 7-years real-world study focused on the analysis of anatomic risk factors predisposing for graft-related reinterventions at mid-term. Patient survival and FFR are satisfactory and compatible with other studies results. Aortic neck diameter and MAIL resulted the main risk factors for FFR. IRAL and MAIL resulting significant factors are not described before and need further investigations.