Key result
Aortic neck >28 mm is linked to ~3.1-fold higher post-EVAR re-intervention risk without compromising 5-year survival.
Why the study?
This study sought to identify anatomical predictors of specific post-discharge re-intervention types after endovascular aneurysm repair (EVAR) and evaluate their association with aneurysm-related survival in an Asian cohort.
What are the anatomical predictors of specific post-discharge re-intervention types and their association with aneurysm-related survival in patients undergoing standard EVAR for abdominal aortic aneurysm?
Cohort (n=596)
No
What are the anatomical predictors of specific post-discharge re-intervention types and their association with aneurysm-related survival in patients undergoing standard EVAR for abdominal aortic aneurysm?
Specific preoperative anatomical features—such as proximal neck diameter >28 mm, AAA diameter >60 mm, common iliac artery diameter ≥18 mm, iliac stenosis, and pre-existing infection—predict distinct post-EVAR re-intervention types, though mid-term aneurysm-related survival remains high (>95%) when complications are detected and treated via surveillance.
Answers are grounded in this paper and cite their sources.
Neck >28 mm may flag higher EVAR re-intervention risk; leaves open whether tailored surveillance improves outcomes in this cohort.
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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Wongwanit et al. (2026) conducted a cohort in Abdominal aortic aneurysm (AAA) treated with standard endovascular aneurysm repair (EVAR) (n=596). Proximal aortic neck diameter > 28 mm (and other adverse anatomical features following EVAR) vs. Proximal aortic neck diameter ≤ 28 mm (or absence of post-discharge re-intervention for survival comparison) was evaluated on Proximal aortic neck-related post-discharge re-intervention (HR 3.096, 95% CI 1.083-8.850, p=0.04). Post-discharge re-intervention occurred in 15.1% after EVAR (predicted by neck >28 mm, aHR 3.096), without reducing 5-year aneurysm-related survival (95.5% vs 96.9%, p=0.31).
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