• Deokbi Hwang, Sujin Park, Hyung-Kee Kim, Jong-Min Lee, and Seung Huh.
• Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea.
• Ann Vasc Surg. 2017 Aug 1; 43: 134-143.

BackgroundWe aim to determine the reintervention rate after open aortic aneurysm repair (OAR) or endovascular aneurysm repair (EVAR) according to compliance or noncompliance with the instructions for use (IFU) for commercial endovascular stent grafts.MethodsAfter exclusion of those with a ruptured abdominal aortic aneurysm (AAA) and isolated iliac artery aneurysm with or without a small AAA (diameter < 5 cm), 240 patients received OAR or EVAR for a nonruptured AAA between January 2006 and March 2016. EVAR was performed from October 2009. Patients were divided into 3 groups: OAR (n = 146), IFU EVAR (n = 42), and non-IFU EVAR (n = 52). Reintervention was defined as graft-related or laparotomy-related (with an abdominal incision after initial laparotomy) reoperations either during the index admission period or later. Final endoleak after EVAR was defined as persistent type I or III endoleak before exiting operating room after various procedures to eliminate the endoleak.ResultsThere were 2 in-hospital deaths in the OAR group caused by reperfusion injury or pancreatitis. There was no in-hospital mortality in the EVAR group. Final endoleak was more common in non-IFU EVAR compared with IFU EVAR (17% vs. 0%; P = 0.004). The mean follow-up duration was 42.1 months, 25.3 months, and 25.0 months in the OAR, IFU EVAR, and non-IFU EVAR groups, respectively. Respective reintervention-free survival (RFS) rates at 1 and 3 years differed significantly by group: 97% and 95% in the OAR group, 100% and 96% in the IFU EVAR group, and 89% and 87% for non-IFU EVAR group (P = 0.043) with a higher reintervention rate in the non-IFU EVAR than in the OAR group. There was no significant difference in RFS rate between the OAR and IFU EVAR groups (P = 0.881). Overall survival (OS) rates at 1 and 3 years, respectively, were 94% and 78% in the OAR group, 90% and 86% in the IFU EVAR group, and 93% and 56% in the non-IFU EVAR group (P = 0.098). There were no significant differences between the OAR and IFU EVAR groups (P = 0.890).ConclusionsIn contrast to IFU EVAR group, the RFS and OS rates of non-IFU EVAR group were lower than in the OAR group during mid-term follow-up. Final endoleak was more frequent, and reintervention was more commonly performed in the non-IFU group than in the IFU group. Therefore, performing EVAR in non-IFU situations should be planned carefully.Copyright © 2017 Elsevier Inc. All rights reserved.

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