Outcomes of endovascular repair for infrarenal abdominal aortic aneurysm at the Cardiovascular Center, E Hospital: a case series and multi-center data comparison

Abstract

Background: Endovascular aneurysm repair (EVAR) has become a widely adopted modality for infrarenal abdominal aortic aneurysms (AAA). Despite its minimally invasive nature, device-related and anatomical complications remain significant challenges.  Objectives: To evaluate the clinical characteristics, anatomical features, procedural techniques, and mid-term outcomes of EVAR at E Hospital, and to compare these findings with national data.  Methods: A cross-sectional descriptive study with longitudinal follow-up included 62 patients with infrarenal AAA treated with EVAR between August 2014 and December 2022. Minimum follow-up was 24 months (until December 2024).  Results: Mean age was 72.4 ± 9.8 years; 77.4% were male. Mean maximal aneurysm diameter was 57.2 ± 11.6 mm. Successful stent-graft deployment was achieved in 96.8%. In-hospital mortality was 1.9%. During mid-term follow-up (mean 48 ± 12 months), 2 cases of Type I endoleak (1 IA, 1 IB) requiring re-intervention and 1 Type II endoleak were recorded. Notably, acute lower limb ischemia related to percutaneous closure devices (Perclose) occurred in 3 cases, necessitating surgical bailout. No late aneurysm ruptures were observed. Non-AAA related mid-term mortality was 7.6%.  Conclusions: EVAR is a feasible procedure providing high survival rates and effective aneurysm exclusion. However, access-site vascular complications and Type I endoleaks remain significant limitations. Meticulous anatomical assessment of the proximal neck and cautious use of percutaneous closure devices are crucial for improving clinical outcomes.