Stentgraft Limb Occlusion After Endovascular Aneurysm Repair: Incidence and Risk Factors

INTRODUCTION: Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors.

METHODS: All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study. Demographic data, cardiovascular risk factors, aneurysm characteristics, arterial anatomy, repair strategy, systemic and stentgraft-related complications, and in-hospital and late mortality were collected. Routine follow-up included duplex examination and/or CT angiography at 3 months, 12 months and annually thereafter. Logistic regression analysis was performed to detect predictors for SLO.

RESULTS: A total of 221 patients (425 stentgraft limbs) were included; of whom 11 patients (5.0%) occluded. Median time to occlusion was 3.3 months and most of the patients presented ischemic signs. Two risk factors for SLO could be identified: symptomatic aneurysm (P .015, odds ratio 4.62, 95% confidence interval 1.35-15.86) and length of the infrarenal abdominal aortic aneurysm (AAA) (P .021, odds ratio 1.31, 95% confidence interval 1.04 - 1.64).

CONCLUSION: The incidence of SLO after EVAR is low, and most occlusions occur within the first year. Predictors for SLO are the symptomatic aneurysm and the length of the infrarenal AAA. Further research is necessary to pool all predictors and to assess the clinical impact of different follow-up strategies for high-vs low-risk patients.