TY - JOUR
T1 - National Numbers of Secondary Aortic Reinterventions after Primary Abdominal Aortic Aneurysm Surgery from the Dutch Surgical Aneurysm Audit
AU - Dutch Society of Vascular Surgery
AU - Steering Committee of the Dutch Surgical Aneurysm Audit
AU - the Dutch Institute for Clinical Auditing
AU - Karthaus, Eleonora G.
AU - Vahl, Anco
AU - Elsman, Bernard H.P.
AU - Wouters, Michel W.J.M.
AU - de Borst, Gert J.
AU - Hamming, J. F.
AU - Van den Akker, P. J.
AU - Akkersdijk, G. J.
AU - Akkersdijk, G. P.
AU - Akkersdijk, W. L.
AU - van Andringa de Kempenaer, M. G.
AU - Arts, C. H.
AU - Avontuur, J. A.
AU - Bakker, O. J.
AU - Balm, R.
AU - Barendregt, W. B.
AU - Bekken, J. A.
AU - Bender, M. H.
AU - Bendermacher, B. L.
AU - van den Berg, M.
AU - Berger, P.
AU - Beuk, R. J.
AU - Blankensteijn, J. D.
AU - Bleker, R. J.
AU - Blok, J. J.
AU - Bode, A. S.
AU - Bodegom, M. E.
AU - van der Bogt, K. E.
AU - de Bruin, J. L.
AU - Hoksbergen, A. W.
AU - Huisman, L. C.
AU - Idu, M. M.
AU - Jacobs, M. J.
AU - Jongkind, V.
AU - Koelemaij, M. J.
AU - Konings, R.
AU - Legemate, D. A.
AU - Lensvelt, M. M.
AU - Mattens, E. C.
AU - Nederhoed, J. H.
AU - Nieuwenhuis, D. H.
AU - Scholtes, V. P.
AU - Stigter, D. A.
AU - Truijers, M.
AU - Verhagen, H. J.
AU - Visser, M. J.
AU - Vlijmen-van Keulen, C. J.
AU - Wiersema, A. M.
AU - Wisselink, W.
AU - van Zeeland, M. L.
AU - Boll, A. P.
AU - Booster, M. H.
AU - Borger van der Burg, B. L.
AU - Bos-van Rossum, W. T.
AU - Bosma, J.
AU - Botman, J. M.
AU - Bouwman, L. H.
AU - Brehm, V.
AU - de Bruijn, M. T.
AU - Brummel, P.
AU - van der Laan, M. J.
AU - Ünlü, Cagdas
AU - de Vries, M.
AU - van der Laan, M. J.
AU - Ünlü, Ç
AU - de Vries, M.
PY - 2020/10
Y1 - 2020/10
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
UR - http://www.scopus.com/inward/record.url?scp=85085650832&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.avsg.2020.04.034
DO - https://doi.org/10.1016/j.avsg.2020.04.034
M3 - Article
C2 - 32335253
SN - 0890-5096
VL - 68
SP - 234
EP - 244
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
ER -