A systematic review and meta-analysis of proximal aortic neck dilatation after endovascular abdominal aortic aneurysm repair

Chatzelas, Dimitrios A.; Loutradis, Charalampos; Pitoulias, Apostolos G.; Kalogirou, Thomas E.; Pitoulias, Georgios A.

doi:10.1016/j.jvs.2022.07.182

Cited by 10 publications

(4 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This scoping review confirmed that PND is a frequent finding during long-term follow-up after endovascular repair of AAA: in particular, up to 41% of EVAR may reveal a significant enlargement of PAN, as confirmed on contrast-enhanced cross-sectional imaging. These results are slightly different from previous evidence that reported an incidence after EVAR of approximately 23%, probably because of our longer follow-up and the inclusion of FEVAR cases [ 19 , 20 ]. The mechanism resulting in PND is likely multifactorial and mainly depends on the combination of several factors including natural history of degenerative aortic disease and mechanical effects of endografts into the aortic lumen [ 21 ].…”

Section: Discussioncontrasting

confidence: 99%

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Mezzetto

D’Oria

Lepidi

et al. 2023

JCM

View full text Add to dashboard Cite

Background: To define proximal neck dilation (PND) after standard endovascular aneurysm repair (EVAR) and fenestrated EVAR (FEVAR), determining: incidence and risk factors; evidence base that links PND to outcomes of patients; recurring themes or gaps in the literature. Methods: We performed a scoping review and included only full-text English articles with follow-up focusing on PND in patients undergoing EVAR or FEVAR, published between 2000 and 2022. The following PICO question was used to build the search equation: in patients with abdominal-aortic-aneurysm (AAA) (Population) undergoing endovascular repair (Intervention), what are the incidence, risk factors and prognosis of radiologically defined PND (Comparison) on short-term and long-term outcomes (Outcomes)? Results: 15 articles were included after review. Measurement protocols for proximal aortic neck (PAN) varied among individual studies and the definition of PND resulted as heterogeneous. Rate of patients with a PND ranged between 0% and 41%. Large proximal neck (>28 mm) and excessive graft sizing (30%) were predictors for PND. New endografts with low outward radial forces and FEVAR seemed to be protective. Surgical conversion was the definitive option in the case of patients unfit for other endovascular treatments. Conclusions: PND is a frequent finding after EVAR and FEVAR. Excessive graft oversizing and large baseline PAN were predictors of neck enlargement, independently by the type of standard endograft used. FEVAR may be considered protective against complications, together with endografts using low outward radial forces. Lifelong radiological follow-up is mandatory.

show abstract

Section: Discussioncontrasting

confidence: 99%

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Mezzetto

D’Oria

Lepidi

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…Despite variation in treatment and follow-up protocols in the studies analyzed, this systemic review and meta-analysis found statistically significant changes in aortic diameter post-TEVAR. The findings in our study align with previously established results regarding aortic morphological post-TEVAR for the treatment of degenerative disease as well as, aortic morphological post-EVAR [31][32][33]. This suggests that the procedure may have a long-term impact on aortic morphology.…”

Section: Discussionsupporting

confidence: 91%

A Systematic Review and Meta-Analysis of Aortic Morphological Changes after Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury

Righini,

Avishay,

Mazzaccaro

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: Thoracic endovascular aortic repair (TEVAR) has become the standard treatment for blunt thoracic aortic injury (BTAI). Some small observational studies revealed aortic morphological changes after TEVAR in patients with BTAI. However, these studies were limited by the rarity of the condition and small sample sizes. To address this gap, the current study aims to conduct a systematic review and meta-analysis of existing literature to provide evidence on the degree of immediate and long-term aortic diameter change following TEVAR for BTAI. Methods: This systematic review and meta-analysis of studies published up to March 2023, was conducted in accordance with the PRISMA statement. Studies eligible for inclusion were studies evaluating aortic diameter change post-TEVAR in BTAI patients. Results: 14 articles, including 353 patients, were included after review. Treatment and measurement protocols varied among individual studies resulting in high heterogeneity of the results. Our meta-analysis demonstrated an immediate post-intervention dilation 2.41 mm and 2.63 mm of the proximal and distal aortic necks’, respectively, as well as continuous dilation of the respective regions at a rate of 0.35 mm/year and 0.49 mm/year. Conclusion: TEVAR in BTAI leads to immediate post-intervention and continuous aortic dilation and morphological changes with possible future important clinical consequences.

show abstract

“…This is an important cause of decreasing apposition in the aortic neck, either a decrease at the proximal sealing zone due to proximal aortic neck dilatation or a decrease at the distal sealing zone due to aneurysm growth and endoleaks. The occurrence of proximal aortic neck dilatation and its increased risk for type 1a endoleak was also reported by Kouvelos et al [ 25 ] and Chatzelas et al [ 26 ]. The postoperative proximal aortic neck dilatation might be due to (too large) oversizing and the radial force of the endograft, or the use of suprarenal fixating endografts [ 27 , 28 , 29 ].…”

Section: Discussionsupporting

confidence: 73%

Diminishing Endograft Apposition during Follow-Up Is an Important Indicator of Late Type 1a Endoleak after Endovascular Aneurysm Repair

Zuidema

Geraedts

Veldhuizen

et al. 2023

JCM

View full text Add to dashboard Cite

Late type 1a endoleaks (T1aELs) after endovascular aneurysm repair (EVAR) are hazardous complications which should be avoided. This study investigated the evolution of the shortest apposition length (SAL) post-EVAR and hypothesised that a declining apposition during follow-up may be an indicator of T1aEL development. Patients with a late T1aEL were selected from a consecutive multicentre database. For each T1aEL patient, the preoperative computed tomography angiography (CTA), first postoperative CTA, and pre-endoleak CTA were analysed. T1aEL patients were matched 1:1 to uncomplicated controls, based on endograft type and follow-up duration. Anatomical characteristics and endograft dimensions, including the post-EVAR SAL, were measured. Included were 28 patients with a late T1aEL and 28 matched controls. The SAL decreased from 11.2 mm (5.6–20.6 mm) to 3.9 mm (0.0–11.4 mm) in the T1aEL group (p = 0.006), whereas an increase in SAL was seen in the control group from 21.3 mm (14.1–25.8 mm) to 25.4 mm (19.0–36.2 mm; p = 0.015). On the pre-endoleak CTA, 18 patients (64%) in the T1aEL group had a SAL < 10 mm, and one (4%) patient in the control group had a SAL < 10 mm on the matched CTAs. Moreover, three mechanisms of decreasing sealing zone were identified, which might be used to determine optimal imaging or reintervention strategies. Diminishing SAL < 10 mm is an indicator for T1aEL during follow-up, it is imperative to include apposition analysis during follow-up.

show abstract

A systematic review and meta-analysis of proximal aortic neck dilatation after endovascular abdominal aortic aneurysm repair

Cited by 10 publications

References 47 publications

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

A Systematic Review and Meta-Analysis of Aortic Morphological Changes after Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury

Diminishing Endograft Apposition during Follow-Up Is an Important Indicator of Late Type 1a Endoleak after Endovascular Aneurysm Repair

Contact Info

Product

Resources

About