Determination of Endograft Apposition, Position, and Expansion in the Aortic Neck Predicts Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

Abstract

Progressive changes in dimensions of the endograft within the infrarenal neck could be detected on regular CTA scans before the complication became urgent in many patients.

A systematic review of standardized methods for assessment of endograft sealing on computed tomography angiography post-endovascular aortic repair, and its influence on endograft-associated complications

“…After the 23 full-text papers were read for eligibility, 10 additional studies were removed because eight studies did not include measurement of endograft position relative to an anatomical landmark or endograft apposition with the arterial vessel wall, one study measured these parameters from 2D digital subtraction angiography images, and one study reported measurements on fewer than 10 patients. The remaining 13 studies were included in this review [4][5][6][7][8][13][14][15][16][17][18][19][20]. A flowchart of the selection procedure is shown in Figure 1.…”

“…Quantitative analysis was not performed because of the heterogeneity of study design, patient inclusion, end points, follow-up, and measurement methods. Five studies assessed the endograft in the proximal landing zone in the aortic neck after EVAR [8,14,17,19,20], three studies assessed the distal landing zone in the common iliac arteries (CIAs) after EVAR [6,7,16], and three studies assessed proximal and distal landing zones [4,5,15]. One study assessed the proximal landing zone after TEVAR [13], and one assessed the distal landing zone after TEVAR [18].…”

“…Measurement precision has been validated for proximal apposition in the aortic neck and for the distance between the proximal edge of the endograft fabric and the renal arteries [17,20]. The method has been used to determine endograft apposition in the aortic neck [8,17] and endograft position in the aortic neck relative to the renal arteries [8,17,20].…”

“…Risk of bias for selection was low (mean score, 3.7 of 4) but was high for comparability (mean score, 0.7 of 2) and for outcome (mean score, 1.3 of 3). Seven studies were designed to compare patients with endograft-associated complications, AAA-associated complications, or re-intervention to controls with endograft apposition or position as an end point (Supplementary Table 2) [4,[6][7][8]13,15,19]. Risk of bias for selection was low (mean score, 3.6 of 4) but high for comparability (0.3 of 2) and moderate for exposure (1.6 of 3).…”

“…Accurate measurement of the endograft position relative to anatomical landmarks and proximal and distal endograft apposition with the arterial wall on the first postoperative CTA scan can stratify the patient's risk for future complications [4][5][6][7]. Comparing these endograft properties during follow-up reveals subtle changes that may precede later complications [8].…”