Does chronic oral anticoagulation with warfarin affect durability of endovascular aortic aneurysm exclusion in a midterm follow-up?

Matthias Biebl, Albert G. Hakaim, W. Andrew Oldenburg, Josef Klocker, Louis L. Lau, Beate Nauhauser, J. Mark McKinney, Ricardo Paz-Fumagalli

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations

Abstract

Purpose: To evaluate the effect of oral anticoagulation on durability of endovascular aortic aneurysm repair (EVAR). Methods: Retrospective review was conducted of 182 consecutive EVAR patients (169 men; mean age 75.3 years, range 53-89) between 1999 and 2003. Patients on warfarin anticoagulation (WA, n=21; International Normalized Ratio of 2 to 3) were compared against a control group (CG) with no postoperative anticoagulation (n=161). Death, aneurysm rupture, and reintervention were considered primary endpoints, endoleaks, endograft migration, and aneurysm remodeling were secondary endpoints. Results: Mean follow-up was 16.3±12.6 months. One-year mortality was 6.6% (9.5% WA versus 6.2% CG); overall mortality was 14.3% (p=0.414). No aneurysm rupture occurred. At 1, 2, and 3 years, respectively, cumulative reinterventions (20%/20%/20% WA versus 12%/15%/20% CG; p=0.633) and endoleak rates (25%/25%/25% WA versus 17%/22%/34% CG; p=0.649) were comparable. In both groups, most completion endoleaks resolved (42.9% WA versus 74.4% CG; p=0.474), but few de novo endoleaks did (0% WA versus 12.8% CG; p=0.538). Anticoagulation did not affect mean time to aneurysm sac shrinkage (1.3±0.3 WA versus 1.4±0.1 years CG; p=0.769). Conclusions: After EVAR, anticoagulation appears safe and does not significantly alter mortality, risk for rupture, or the incidence of reintervention. Early endoleaks appear more common in anticoagulated patients, but anticoagulation does not preclude spontaneous endoleak resolution nor does it increase late endoleak rates. Irrespective of the anticoagulation status, early but not late endoleaks usually sealed spontaneously. Observing type II endoleaks appears safe in the absence of aneurysm enlargement.

Original languageEnglish (US)
Pages (from-to)58-65
Number of pages8
JournalJournal of Endovascular Therapy
Volume12
Issue number1
DOIs
StatePublished - Feb 1 2005

Keywords

  • Abdominal aortic aneurysm
  • Aneurysm rupture
  • Anticoagulation
  • Endoleak
  • Endovascular repair
  • Sac remodeling
  • Sac shrinkage
  • Secondary procedures
  • Survival
  • Warfarin

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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