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The evolution of Z stent-based stent-grafts for endovascular aneurysm repair: a life-table analysis of 7.5-year followup.

Resch, Timothy; Malina, Martin LU ; Lindblad, Bengt LU and Ivancev, Krassi LU (2002) In Journal of the American College of Surgeons1994-01-01+01:00 194(1 Suppl). p.74-78
Abstract
BACKGROUND: The purpose of this study was to analyze the impact of stent-graft design and operator skills on outcomes after endovascular abdominal aortic aneurysm repair. STUDY DESIGN: One hundred sixty-four patients (mean age 71 years) underwent stent-graft repair. Patients were treated with four different types of stent-graft: first-generation (n = 58) and second-generation (n = 17) Ivancev-Malmö monoiliac stent-grafts (IM I and IM II, respectively) combined with femoral-femoral crossover, Chuter bifurcated stent-graft (n = 15), and the Zenith stent-graft (n = 74). Patients underwent digital subtraction angiography and contrast CT preoperatively and were then followed with CT scans postoperatively. Recently, followup was changed to CT... (More)
BACKGROUND: The purpose of this study was to analyze the impact of stent-graft design and operator skills on outcomes after endovascular abdominal aortic aneurysm repair. STUDY DESIGN: One hundred sixty-four patients (mean age 71 years) underwent stent-graft repair. Patients were treated with four different types of stent-graft: first-generation (n = 58) and second-generation (n = 17) Ivancev-Malmö monoiliac stent-grafts (IM I and IM II, respectively) combined with femoral-femoral crossover, Chuter bifurcated stent-graft (n = 15), and the Zenith stent-graft (n = 74). Patients underwent digital subtraction angiography and contrast CT preoperatively and were then followed with CT scans postoperatively. Recently, followup was changed to CT scanning at 1 month and 1 year postoperatively and annually thereafter. Ultrasonographic duplex scanning substitutes in the remaining followup. Changes in aneurysm diameters and occurrence of endoleaks were recorded. Short- and midterm mortality and complications and postoperative secondary interventions were recorded, and life-table analysis for intervention-free stent-graft survival was calculated. RESULTS: Immediate and late conversions and 30-day mortality were reduced for second- (IM II and Zenith) compared with first-generation stent-grafts (IM I and Chuter). Stent-graft migrations occurred only with the IM I and Chuter stent-grafts. Type I endoleak was significantly more common in first-generation stent-grafts. First-generation stent-grafts required significantly more secondary interventions than second-generation stent-grafts up to 30 months postoperatively. CONCLUSION: Enhanced stent-graft design has improved the probability of stent-graft success after endovascular abdominal aortic aneurysm repair. Better technical skills and increased use of intraoperative adjunctive procedures may also have contributed to improved results. (Less)
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Contribution to journal
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published
subject
keywords
Life Tables, Human, Female, Equipment Design, Factual, Databases, Abdominal/radiography/*surgery, Aortic Aneurysm, 80 and over, Aged, Male, Middle Age, Postoperative Complications/*mortality, *Stents
in
Journal of the American College of Surgeons1994-01-01+01:00
volume
194
issue
1 Suppl
pages
74 - 78
publisher
Elsevier Inc.
external identifiers
  • wos:000173155400011
  • pmid:11800358
  • scopus:0036139765
ISSN
1879-1190
DOI
10.1016/S1072-7515(01)01102-4
language
English
LU publication?
yes
id
025d0b1f-9523-4c89-93d1-77644ec7d78c (old id 346076)
alternative location
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11800358&dopt=AbstractPlus
date added to LUP
2007-07-30 11:27:36
date last changed
2017-01-01 04:55:34
@article{025d0b1f-9523-4c89-93d1-77644ec7d78c,
  abstract     = {BACKGROUND: The purpose of this study was to analyze the impact of stent-graft design and operator skills on outcomes after endovascular abdominal aortic aneurysm repair. STUDY DESIGN: One hundred sixty-four patients (mean age 71 years) underwent stent-graft repair. Patients were treated with four different types of stent-graft: first-generation (n = 58) and second-generation (n = 17) Ivancev-Malmö monoiliac stent-grafts (IM I and IM II, respectively) combined with femoral-femoral crossover, Chuter bifurcated stent-graft (n = 15), and the Zenith stent-graft (n = 74). Patients underwent digital subtraction angiography and contrast CT preoperatively and were then followed with CT scans postoperatively. Recently, followup was changed to CT scanning at 1 month and 1 year postoperatively and annually thereafter. Ultrasonographic duplex scanning substitutes in the remaining followup. Changes in aneurysm diameters and occurrence of endoleaks were recorded. Short- and midterm mortality and complications and postoperative secondary interventions were recorded, and life-table analysis for intervention-free stent-graft survival was calculated. RESULTS: Immediate and late conversions and 30-day mortality were reduced for second- (IM II and Zenith) compared with first-generation stent-grafts (IM I and Chuter). Stent-graft migrations occurred only with the IM I and Chuter stent-grafts. Type I endoleak was significantly more common in first-generation stent-grafts. First-generation stent-grafts required significantly more secondary interventions than second-generation stent-grafts up to 30 months postoperatively. CONCLUSION: Enhanced stent-graft design has improved the probability of stent-graft success after endovascular abdominal aortic aneurysm repair. Better technical skills and increased use of intraoperative adjunctive procedures may also have contributed to improved results.},
  author       = {Resch, Timothy and Malina, Martin and Lindblad, Bengt and Ivancev, Krassi},
  issn         = {1879-1190},
  keyword      = {Life Tables,Human,Female,Equipment Design,Factual,Databases,Abdominal/radiography/*surgery,Aortic Aneurysm,80 and over,Aged,Male,Middle Age,Postoperative Complications/*mortality,*Stents},
  language     = {eng},
  number       = {1 Suppl},
  pages        = {74--78},
  publisher    = {Elsevier Inc.},
  series       = {Journal of the American College of Surgeons1994-01-01+01:00},
  title        = {The evolution of Z stent-based stent-grafts for endovascular aneurysm repair: a life-table analysis of 7.5-year followup.},
  url          = {http://dx.doi.org/10.1016/S1072-7515(01)01102-4},
  volume       = {194},
  year         = {2002},
}