Can We Confirm Lower All-Cause Mortality Following Endovascular Aneurysm Sealing Compared With Endovascular Aneurysm Repair After Longer Follow-Up?

Since the introduction of first endovascular aneurysm sealing device (EVAS-1) by Nellix System (Endologix, Inc, Irvine, CA), studies have demonstrated high reintervention and migration rates. However, prior reports showed higher 3-year survival compared with repair (EVAR), which gave rise to interesting theories on explanation this observation. In study, we examined 5-year all-cause mortality trends EVAS-1 EVAR. We 333 patients in U.S. investigational exemption study 16,497 controls from Vascular Quality Initiative between 2014 2016 after applying exclusion criteria (hemodialysis, creatinine >2.0 mg/dL, and/or rupture). As a secondary analysis, stratified primary analysis diameter (<5.5 cm vs >5.5 cm). calculated propensity scores adjusting for demographics, comorbidities, anatomic characteristics, applied inverse probability weighting compare risk-adjusted long-term using Kaplan-Meier Cox regression analyses. After weighting, treated experienced similar (EVAS-1 EVAR, 18% 14%; hazard ratio [HR], 1.1; 95% confidence interval [CI], 0.71-1.7; P = .70). The subgroup that an <5.5 cm, was associated EVAR (19% 11%; HR, 2.4; CI, 1.7-4.7; .013; Fig 1). those aneurysms association lower found 2 years (2-year mortality: 0.29; 0.13-0.62; .002). lost over time, curves crossed at 4 years, no overall difference (18% 17%; 0.82; 0.48-1.4; .46; 2). contrast earlier reports, did not find 5 EVAS-1. Sac obliteration favorable smaller aneurysms. Nevertheless, concept could hold some promise because seem be initial within years. advantage rapidly 3 Future extended follow-up are necessary explore whether sac is rates cardiovascular events delineate mechanism leads benefit.Fig 2Adjusted (P .55; all standard errors, <0.1). Endovascular repair; EVAS, sealing.View Large Image Figure ViewerDownload Hi-res image Download (PPT)