Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern Salvatore T. Scali, MD, Robert J. Feezor, MD,

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Presentation transcript:

Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern Salvatore T. Scali, MD, Robert J. Feezor, MD, Catherine K. Chang, MD, Alyson L. Waterman, MD, MPH, Scott A. Berceli, MD, PhD, Thomas S. Huber, MD, PhD, Adam W. Beck, MD Journal of Vascular Surgery Volume 60, Issue 4, Pages 865-874.e1 (October 2014) DOI: 10.1016/j.jvs.2014.03.295 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 This Kaplan-Meier curve demonstrates the estimated probability of primary stent patency up to 3 years (n = 76 stents). Overall, nine stents (one celiac, six renal, and two superior mesenteric artery) occluded. Seven of those occlusions (9%) occurred within 3 years. Accounting for patients with less than 3 years of follow-up, the estimated probability of primary patency at 3 years is 85% (95% confidence interval, 75%-95%). The standard error of the mean is <10% at all displayed intervals. Journal of Vascular Surgery 2014 60, 865-874.e1DOI: (10.1016/j.jvs.2014.03.295) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 This Kaplan-Meier curve demonstrates the estimated probability of freedom from reintervention after chimney endovascular aneurysm repair (EVAR) up to 3 years. Overall, three of 41 patients experienced the need for reintervention. Only one of those reinterventions occurred within 3 years. Accounting for patients with less than 3 years of follow-up, the Kaplan-Meier estimated probability of freedom from reintervention at 3 years is 96% (95% confidence interval, 88%-99%). The standard error of the mean is <10% at all displayed intervals. Journal of Vascular Surgery 2014 60, 865-874.e1DOI: (10.1016/j.jvs.2014.03.295) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 This Kaplan-Meier curve demonstrates the estimated probability of freedom from a major adverse event (MAE) up to 3 years after chimney endovascular aneurysm repair (chEVAR). Overall, 13 of 41 patients suffered a MAE, which included chimney stent thrombosis, type Ia endoleak in follow-up, reintervention, 30-day/in-hospital death, and ≥25% decrease in estimated glomerular filtration rate (eGFR) after discharge. Twelve of these MAEs occurred within 3 years. Accounting for patients with less than 3 years of follow-up, the Kaplan-Meier estimated probability of freedom from MAE at 3 years is 57% (95% confidence interval, 37%-77%). The standard error of the mean is <10% at all displayed intervals. Journal of Vascular Surgery 2014 60, 865-874.e1DOI: (10.1016/j.jvs.2014.03.295) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 This Kaplan-Meier curve demonstrates the estimated probability of survival up to 3 years after chimney endovascular aneurysm repair (chEVAR). At 3 years, 58% (95% confidence interval, 39%-74%) of patients were alive after repair, which is consistent with published reports of open aortic repair. The standard error of the mean is <10% at all displayed intervals. Journal of Vascular Surgery 2014 60, 865-874.e1DOI: (10.1016/j.jvs.2014.03.295) Copyright © 2014 Society for Vascular Surgery Terms and Conditions