Results From 11-Year Study of Debranching With Aortic Stent Grafts for Complex Aneurysms Presented at SVS

June 18, 2011—The Society for Vascular Surgery (SVS) announced that clinical data on patients who underwent abdominal debranching combined with aortic stent grafts (ADSG) were presented at SVS's 2011 annual meeting in Chicago. The study included 167 patients treated at 12 centers in North America from 1999 through 2010.

Principal Investigator Gustavo S. Oderich, MD, noted that the study data were provided from the North American Complex Abdominal Aortic Debranching Registry. The study's endpoints were mortality, morbidity, graft patency, patient survival, and stent graft–related complications.

“We found that ADSG is associated with high early mortality,” commented Dr. Oderich. “The wide variation in mortality rates among large volume centers (0%–24%) indicates differences in patient selection, comorbidities, the extent of aneurysm repair, and the use of a single- versus two-stage approach.”

As detailed by the SVS, the 30-day in-hospital mortality rate was 16% (27 patients). Mortality was higher for thoracoabdominal aortic aneurysms than for pararenal aortic aneurysms (19% vs 10%; P < .05) and ranged from 0% to 24% in centers with fewer than 10 cases. The rate of aneurysm rupture before the second stage was 4% (3 patients). The morbidity rate was 49% (83 patients), including pulmonary (32%) or gastrointestinal complications (18%). Patients also had myocardial ischemia (14%), renal insufficiency (14%), and spinal cord injury (8%).

Factors associated with increased mortality (P < .05) were advanced age, coronary artery disease, congestive heart failure, renal insufficiency, thoracoabdominal aortic aneurysm extent, having fewer than three vessels reconstructed, and single-stage procedures. At 1-year, the patient survival rate was 72% ± 8%, and the primary graft patency rate was 95% ± 4%. The rates of freedom from endoleak, secondary intervention, and aneurysm-related death were 87% ± 6%, 86% ± 6%, and 82% ± 6%, respectively.

“These preliminary data serve as a benchmark for comparison with open surgical and total endovascular techniques to repair complex aortic aneurysm,” concluded Dr. Oderich. “However, long-term follow-up is needed to evaluate the durability of ADSG.”