Outcome of Single Versus Dual Antiplatelet Therapy After Complex Endovascular Aortic Repair

Abstract

Introduction: Despite the widespread use of branched (bEVAR) and fenestrated endovascular aortic repair (fEVAR) for complex aortic pathologies, there are no reliable recommendations regarding postsurgery antiplatelet therapy. We therefore evaluated the outcome of single (SAPT) and dual antiplatelet therapy (DAPT) following fEVAR and bEVAR.

Methods: A total of 63 patients from two German centers treated for complex aortic pathologies were included in this retrospective study. Patient data and computed tomography angiograms were analyzed. Kaplan-Meier analyses for overall survival and freedom from target vessel (TV)-related complications were performed. The outcomes were compared between SAPT versus DAPT and bEVAR versus fEVAR. Univariate logistic regression was applied to analyze the correlation between TV patency and various anatomical aortic parameters.

Results: In total, 30 patients were treated with fEVAR and 33 with bEVAR. Of these, 19 patients received SAPT and 44 received DAPT postsurgery. Anatomical aortic characteristics and comorbidities were comparable among groups. Overall survival was 95% (±5.1) for SAPT and 88% (±8.8) for DAPT after 36 mo of follow-up. Patency was evaluated individually for each TV SAPT versus DAPT (celiac trunk 100% ± 0 versus 87% ± 9.6; superior mesenteric artery 86% ± 13.2 versus 100% ± 0; left renal artery 92% ± 8.0 versus 95% ± 3.6; right renal artery 72% ± 15.2 versus 81% ± 9.9). Freedom from endoleak was 35% (±13.7) for SAPT versus 30% (±13.8) for DAPT. There was no statistically significant difference for SAPT versus DAPT or for bEVAR versus fEVAR. Further, none of the anatomical aortic characteristics and bridging stent graft-related parameters analyzed predicted TV occlusion in logistic regression analysis.

Conclusions: We did not observe differences in overall survival, endoleak, and TV patency rates between SAPT and DAPT treated patients following bEVAR and/or fEVAR. Patient-specific factors therefore appear to be more relevant for the long-term outcomes rather than the antiplatelet regime applied postsurgery.

Keywords: Antiplatelet therapy; Branched endovascular aortic repair; Complex endovascular aortic repair; Fenestrated endovascular aortic repair; Target vessel patency.