Long-term outcome results after endovascular aortoiliac aneurysm repair with the bifurcated Excluder endoprosthesis

ABSTRACT Objective To report the long-term outcome of patients presenting with an aortic, aortoiliac or isolated common iliac aneurysm treated with the EXCLUDER bifurcated endoprosthesis. Furthermore, potential differences in late outcome results between the original and low permeability endoprosthesis were analyzed. Methods A retrospective analysis of prospectively collected data of 182 patients who underwent endovascular aneurysm repair with the Excluder endoprosthesis between June 1998 and October 2015 in an academic, tertiary care center for aortic disease was performed. Patient follow-up was from 3 to 20 years (mean follow-up of 6.9 years). Primary endpoints were overall survival and reintervention-free survival. Secondary endpoints were device-related complications, endoleaks and reinterventions. Results Overall survival at 5, 10 and 15 years was 72.8%, 42.1% and 12.2%, respectively, with no aneurysm-related mortality and no difference in overall survival between original versus low permeability endoprosthesis group (p=0.617). Freedom from type I endoleak at five years was 94.8%. No new type I endoleak was detected beyond the 5-year follow-up mark. No type III endoleak was identified. Reintervention-free survival was 83.6%, 66.7% and 66.7% at 5, 10 and 15 years follow-up, respectively. There was a significant difference in intervention-free survival between the original versus low permeability endoprosthesis group (p=.029) and after the 5-year follow-up mark. Additionally, patients with the low permeability endoprosthesis showed significantly fewer device-related complications (p=.002) and endoleaks (p=.005). Conclusion Endovascular aneurysm repair using the Excluder endoprosthesis is effective and durable on long-term follow-up, with acceptably low device-related complications and reinterventions. The low permeability endoprosthesis was associated with significantly fewer new device-related complications and endoleaks after 5 years of follow-up.