Predictors of major adverse anatomical events after elective endovascular abdominal aortic aneurysm repair at a tertiary referral center

Objectives: We aim to identify the predictors for major adverse anatomical events (MAAE) post-EVAR. Methods: A retrospective observational study was conducted by analyzing the records of all the patients who had undergone EVAR for non-ruptured infra-renal abdominal aortic aneurysm (AAA) from January 2013 to March 2015 in our tertiary referral vascular center. Results: We analyzed the records of 103 patients based on our study objectives with the mean age of 74.43 ± 6.73 years (range: 62 to 90). Total incidence of MAAE was 12.5% (n=13). Thirty-day mortality was 1%. Type II endoleak incidence was 14.6% (n=15). The most common cause of mortality was related to malignancy (5.8%, n=6). Overall five-year survival was 87.4%. Five-year primary and secondary clinical success rates were 77.7 and 87.4%, respectively. Multivariate logistic regression analysis identified female gender (P=0.021), aneurysm maximum transverse diameter (P=0.010), shorter neck length (P=0.015), and iliac angulation (ipsilateral iliac angulation, P=0.019 and contralateral iliac angulation, P=0.045) to be significant predictors of MAAE. Conclusion: Although females are less likely to suffer from AAA, they seem to do worse with elective EVAR. Aneurysm maximum transverse diameter and hostile anatomy are strongly associated with the long-term development of endoleaks and device malfunction.