Post-discharge Re-interventions and Survival Following Endovascular Aneurysm Repair: A Retrospective Cohort Study

Chumpol Wongwanit; Khamin Chinsakchai; Virapat Chanchitsopon; Nattawut Puangpunngam; Tossapol Prapassaro; Kiattisak Hongku; Nuttawut Sermsathanasawadi; Suteekhanit Hahtapornsawan; Kanin Pruekprasert; Sasima Tongsai; Chanean Ruangsetakit

doi:10.33192/smj.v78i11.283350

Authors

Chumpol Wongwanit, M.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Khamin Chinsakchai, M.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Virapat Chanchitsopon, M.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Nattawut Puangpunngam, M.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Tossapol Prapassaro, M.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Kiattisak Hongku, M.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Nuttawut Sermsathanasawadi, Ph.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Suteekhanit Hahtapornsawan, M.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Kanin Pruekprasert, Ph.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Sasima Tongsai, Ph.D. Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Chanean Ruangsetakit, M.D. Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v78i11.283350

Keywords:

Abdominal aortic aneurysm, anatomical predictors, endovascular aneurysm repair, post-discharge re-intervention, survival analysis

Abstract

Objective: To identify anatomical predictors of specific post-discharge re-intervention types following endovascular aneurysm repair (EVAR) and evaluate their association with aneurysm-related survival in an Asian cohort.

Materials and Methods: This retrospective cohort study analyzed prospectively maintained data from 596 patients who underwent EVAR at a single center between 2010 and 2021. Post-discharge re-interventions were categorized according to anatomical location. Anatomical predictors were identified using multivariable Cox proportional hazards regression. Aneurysm-related survival was evaluated using Kaplan-Meier analysis. The median follow-up duration was 36 months.

Results: Ninety patients (15.1%) underwent post-discharge re-intervention during follow-up. The most common indications were proximal aortic neck (35.5%) and distal landing zone (26.7%). Proximal complications were predicted by neck diameter >28 mm (adjusted HR 3.096, p = 0.04) and aneurysm diameter >60 mm (adjusted HR 2.439, p = 0.01). A common iliac artery diameter ≥18 mm predicted distal landing zone-related re-interventions (adjusted HR 2.703, p = 0.03). Iliac stenosis was independently associated with limb occlusion (adjusted HR 4.237, p = 0.04), whereas pre-existing infected abdominal aortic aneurysm strongly predicted endograft infection (adjusted HR 8.065, p = 0.02). Five-year aneurysm-related survival was 95.5% in the re-intervention group versus 96.9% in the non-re-intervention group (p = 0.31).

Conclusion: Specific anatomical features predict distinct re-intervention types after EVAR and may facilitate individualized risk stratification and surveillance planning. Despite the need for secondary procedures in a subset of patients, aneurysm-related survival remained excellent, supporting the mid-term durability of EVAR when combined with appropriate monitoring.

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