Evaluation of Long-term Outcomes, Complications, and Treatment Efficiency in Abdominal Aortic Aneurysm

Objective: The primary goal in the treatment of abdominal aortic aneurysms (AAA) is to reduce long-term morbidity and mortality by preventing aneurysm rupture. This study aimed to evaluate the effect of aneurysm morphology before endovascular aneurysm repair (EVAR) in AAA on prognosis, compare the changes in aneurysm morphology after mid- and long-term follow-up after EVAR with extensive randomized studies, and evaluate the treatment efficacy. Methods: A total of 75 patients who were evaluated with pre-operative computed tomography angiography (CTA) with a preliminary diagnosis of AAA in our institution and had a perioperative digital subtraction angiography examination and at least one post-operative follow-up CTA examination >12 months were included in the study. Additional interventions were recorded during the procedure, complications, endoleak types, demographic data, and changes in aneurysm morphology. The results were compared with the data in the literature. Results: The mean follow-up period was calculated as 37 months. A mean decrease of 4.5 mm was detected in AAA diameter. A mean reduction of 4 mm in thickness was observed in accompanying common iliac artery (CIA) aneurysms (p=0.016). Complications were observed in 32% of the patients. The most common complication was Type 2 endoleak, which was observed in 25% of the patients. We did not observe a significant difference in pre-operative and post-operative mean thrombus thickness (p=0.588). Endoleak rate was increased in patients with bilateral CIA aneurysms accompanying AAA (p=0.044). While there was no significant effect of changing the AAA diameter in those with increasing thrombus diameter, it was observed that the aortic diameter decreased in those with decreasing thrombus diameter (p=0.012). Conclusion: Our 10-year experience with EVAR shows that many complications may occur after stent grafting. Caution should be exercised regarding Type 2 endoleaks. Lifelong follow-up is necessary to prevent aneurysm rupture after EVAR.