A systematic review of anatomic predictors of abdominal aortic aneurysm remodeling after endovascular repair

Rijswijk, R E van; Jebbink, Erik Groot; Zeebregts, Clark J.; Reijnen, Michel M.P.J.

doi:10.1016/j.jvs.2021.11.071

Cited by 16 publications

(18 citation statements)

References 40 publications

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“…Another negative predictive measure for AAA shrinkage was a larger preoperative infrarenal β angle. A recent systematic review demonstrated that two other studies that investigated AAA remodeling one-year after EVAR did not find significant relations between infrarenal angulation and AAA remodeling—in contrast to this study [ 13 ]. However, both studies were not comparable to this study as one study focused only on the Lombard Aorfix high angulation device and used another definition for neck angle [ 25 ], while the other study demonstrated smaller infrarenal angles with an undescribed measurement method of these angles [ 24 ].…”

Section: Discussioncontrasting

confidence: 98%

“…The evidence on a relationship between the preoperative AAA diameter and remodeling after EVAR varies greatly between different published studies—as shown in a recent review [ 13 ]. When focusing on studies reporting specifically on AAA remodeling one-year after EVAR, two studies found no correlation, while two others observed that a larger preoperative AAA diameter was related to an increased likelihood of AAA shrinkage [ 22 , 23 , 24 , 25 ]—consistent with the findings of this analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Lalys et al performed a systematic review and meta-analysis on predictors of AAA shrinkage, but they studied shrinkage at any time during follow-up and not specifically one-year after EVAR [ 12 ]. Furthermore, a recent systematic review of anatomical predictors of AAA remodeling showed that strong consistent evidence on this type of predictor is missing [ 13 ]. It is important though to identify predictors of AAA shrinkage since they also indirectly predict positive long-term outcomes after EVAR.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Rijswijk

Jebbink

Holewijn

et al. 2022

JCM

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Recent studies demonstrate that patients with a shrinking abdominal aortic aneurysm (AAA), one-year after endovascular repair (EVAR), have better long-term outcomes than patients with a stable AAA. It is not known what factors determine whether an AAA will shrink or not. In this study, a range of parameters was investigated to identify their use in differentiating patients that will develop a shrinking AAA from those with a stable AAA one-year after EVAR. Hundred-seventy-four patients (67 shrinking AAA, 107 stable AAA) who underwent elective, infrarenal EVAR were enrolled between 2011–2018. Long-term survival was significantly better in patients with a shrinking AAA, compared to those with a stable AAA (p = 0.038). Larger preoperative maximum AAA diameter was associated with an increased likelihood of developing AAA shrinkage one-year after EVAR—whereas older age and larger preoperative infrarenal β angle were associated with a reduced likelihood of AAA shrinkage. However, this multivariate logistic regression model was only able to correctly identify 66.7% of patients with AAA shrinkage from the total cohort. This is not sufficient for implementation in clinical care, and therefore future research is recommended to dive deeper into AAA anatomy, and explore potential predictors using artificial intelligence and radiomics.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Rijswijk

Jebbink

Holewijn

et al. 2022

JCM

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“…These considerations may justify the relatively low incidence of type IA endoleak and graft migration that were observed in the cohort of patients included in this analysis. Indeed, the efficacy of proximal sealing depends on the combination of several patients-related and graft-related factors, such as neck shape, angulations, calcifications, endoprosthesis fixation (barbs, bare metal stents), and the sole occurrence of 2–3 mm PAN growth from the baseline may be insufficient to cause any clinically relevant proximal neck complications [ 29 , 30 , 31 ]. Although this may represent a potential methodological bias, a continuous growth of the PAN has been well documented in most available literature and lifelong follow-up is recommended both in EVAR and FEVAR procedures, especially when hostile anatomical features of the PAN are present [ 32 ], as also suggested by current clinical practice guidelines [ 33 ].…”

Section: Discussionmentioning

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

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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.

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“…Angulated neck is found to be a predictor for sac enlargement ( 29 ), which is closely linked with postoperative aortic rupture ( 30 ). Sac remodeling, with a close connection with endoleaks, reintervention and mortality, may be affected by hostile neck and AAA volume ( 31 ). There is mounting evidence proving that patients with these hostile anatomical features could suffer from postoperative adverse events more commonly ( 32 – 35 ).…”

Section: Discussionmentioning

confidence: 99%

DANCER: Study protocol of a prospective, non-randomized controlled trial for crossed limb versus standard limb configuration in endovascular abdominal aortic aneurysm repair

Shen

Wang²,

Zhao³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHostile anatomy, especially severely angulated neck and tortuous iliac arteries, has always been a conundrum in endovascular aneurysm repair (EVAR). Crossed limb (CL) graft, also called the “ballerina technique,” has been utilized to address this problem by facilitating gate cannulation. In terms of short and long-term outcomes, correlated studies have made inconsistent conclusions and this issue remains controversial. Based on a previous cohort study conducted in our center, we aim to prospectively compare the safety and efficacy between CL and standard limb (SL) configuration in patients receiving EVAR.MethodsThis is a prospective, single-center, non-randomized controlled trial. A total of 275 patients who meet the inclusion criteria will be enrolled and allocated with a 4:11 ratio of CL to SL, which is based on results of our previous study. All patients will receive same perioperative management and postoperative medications. All EVAR procedures will be performed under standard protocol, utilizing Endurant II or IIs Stent Graft. The configuration of the graft stent will be decided by surgeons and confirmed by final angiography. The primary outcome is 3-year freedom from major adverse limb-graft events (MALEs). Endpoints will be assessed at the following time points: 1, 6, 12, 24, and 36 months.DiscussionTo our best knowledge, this crosseD vs. stANdard Configuration in Endovascular Repair (DANCER) trial is the first non-randomized controlled trial to compare these two graft configurations in EVAR. The main aim is to compare the MALEs between two groups at 3 years postoperatively. This trial will hopefully provide high-level evidence for employing CL in EVAR.Clinical trial registration[www.chictr.org.cn], identifier [ChiCTR2100053055].

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A systematic review of anatomic predictors of abdominal aortic aneurysm remodeling after endovascular repair

Cited by 16 publications

References 40 publications

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

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

DANCER: Study protocol of a prospective, non-randomized controlled trial for crossed limb versus standard limb configuration in endovascular abdominal aortic aneurysm repair

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