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    Long-term results of endovascular intervention with unibody bifurcation endograft for elective abdominal aortic aneurysm management
    (Imr Press, 2021) Iscan, Hakki Zafer; Karahan, Mehmet; Akkaya, Bekir Bogachan; Basar, Veysel; Askin, Goktan; Kubat, Emre; Unal, Ertekin Utku
    Unibody bifurcated endografts have the advantage of reducing the operative time, avoiding migration and iliac limb dislocation in patient with abdominal aortic aneurysm (AAA). We report our longterm experience in patients who underwent endovascular aortic repair (EVAR) due to infrarenal AAA with Endologix AFX (R) endograft system. Between January 2013-December 2018, 68 patients with infrarenal AAA had EVAR procedure with Endologix AFX (R) endograft system. Mean follow-up was 40.4 +/- 19.5 months, and all patients had computed tomography periodically, with colored Doppler ultra-sonography (CDUS) every six months. Mean age was 68.5 +/- 7.1 years and, 63 (92.6%) patients were male. Early mortality, renal complications, stent-graft migration and cardiac complications were not seen in early post-operative period. There was no early mortality in the group and no conversion to open repair. In long-term follow-up 12 patients (17.6%) had endoleak (5 with type II, 7 with type III). Overall survival estimated by Kaplan-Meier analysis was 94.1% at 1 year, 85.2% at 2 years, 74.1% at 3 years and 54.0% at 5 years. Freedom from second intervention and conversion was 98.4% at 1 year, 95.3% at 2 years, 93.3% at 3 years and 87.4% at 5 years. Endologix AFX (R) endo-graft provides a fast, safe and effective endograft for the early period, therefore it seems more suitable for elderly and comorbid patients. This endograft has low reintervention rates however according to our results, aneurysms larger than 6 cm may have more sideway displacement possibility and by this way type III endoleak. Proper patient selection and sufficient overlap are the key issues. Close monitoring is mandatory at the follow-up period.
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    Öğe
    Outcomes after EVAR in females are similar to males
    (Bmc, 2021) Tumer, Naim Boran; Askin, Goktan; Akkaya, Bekir Bogachan; Civelek, Isa; Unal, Ertekin Utku; Iscan, Hakki Zafer
    IntroductionWomen are less likely to develop infrarenal abdominal aortic aneurysm; however, when they do, it is almost always associated with challenging anatomy, more rapid aneurysmal growth rate and earlier rupture. Women generally have poorer outcomes following open aneurysm repair; and in this respect, the present study aims to evaluate if it is so after endovascular repair. MethodsA retrospective analysis of our database was performed for patients underwent endovascular aneurysm repair (EVAR) between January 2013-March 2020. 249 elective EVAR patients were evaluated. Patients were categorized according to gender and 26 patients (10.4%) were female. Demographics and pre-peri-postoperative findings were compared. Propensity score matching (ratio 1:1) was performed to reduce selection bias. ResultsIn the overall unmatched cohort, female population had more diabetes mellitus (p=0.016) and hypertension (p=0.005). However, coronary artery disease (p=0.005) and coronary artery bypass grafting (p=0.006) were more in male gender. Non-IFU implantation was higher in female group (38.5% vs. 11.5%, p=0.025). After propensity matching, even though it was not statistically significant, early mortality for female gender was higher when compared to male gender (7.7% and 0%, respectively, p=0.490). In the follow-up period, no difference in all-cause mortality, secondary interventions or complications have been observed between the genders.ConclusionChallenging anatomy and subsequently treated patients outside IFU may be the reasons for higher morbidity and mortality in women. However, despite these factors female and male patients revealed equivalent early and late results.