Aortic curvature as a predictor of intraoperative type Ia endoleak

Schuurmann, Richte C. L.; Ouriel, Kenneth; Muhs, Bart E.; Jordan, William D.; Ouriel, Richard L.; Boersen, Johannes T.; Vries, J.P.P.M. de

doi:10.1016/j.jvs.2015.08.110

Cited by 26 publications

(26 citation statements)

References 16 publications

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“…A previous study also identified curvature expressed over the infrarenal neck and the aneurysm sac as a predictor for intraoperative type Ia endoleak. 10 Contrary to intraoperative type Ia endoleaks, maximum curvature over the aneurysm sac was more predictive for late failure than average curvature. The maximum curvature over the trajectory of the aneurysm sac was mostly located in the proximal part of the sac, with a median distance of 43.6 mm (IQR 20.8-68.6) below the lower renal artery origin for the complication cohort.…”

Section: Discussionmentioning

confidence: 85%

“…Since early and late complications are often combined in the literature, this study, together with our earlier publication considering intraoperative type Ia endoleak, 10 adds to the understanding of the association between morphological aortic parameters and the onset of complications.…”

Section: Limitationsmentioning

confidence: 89%

“…10 The purpose of this study was to identify preoperative hostile neck characteristics that are predictors of late failure of endograft fixation and apposition in the aortic neck.…”

Section: Introductionmentioning

confidence: 99%

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Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

et al. 2017

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Purpose: To evaluate the association between aortic curvature and other preoperative anatomical characteristics and late (>1 year) type Ia endoleak and endograft migration in endovascular aneurysm repair (EVAR) patients. Methods: Eight high-volume EVAR centers contributed 116 EVAR patients (mean age 81±7 years; 103 men) to the study: 36 patients (mean age 82±7 years; 31 men) with endograft migration and/or type Ia endoleak diagnosed >1 year after the initial EVAR and 80 controls without early or late complications. Aortic curvature was calculated from the preoperative computed tomography scan as the maximum and average curvature over 5 predefined aortic segments: the entire infrarenal aortic neck, aneurysm sac, and the suprarenal, juxtarenal, and infrarenal aorta. Other morphological characteristics included neck length, neck diameter, mural neck calcification and thrombus, suprarenal and infrarenal angulation, and largest aneurysm sac diameter. Independent risk factors were identified using backward stepwise logistic regression. Relevant cutoff values for each of the variables in the final regression model were determined with the receiver operator characteristic curve. Results: Logistic regression identified maximum curvature over the length of the aneurysm sac (>47 m −1 ; p=0.023), largest aneurysm sac diameter (>56 mm; p=0.028), and mural neck thrombus (>11° circumference; p<0.001) as independent predictors of late migration and type Ia endoleak. Conclusion: Aortic curvature is a predictor for late type Ia endoleak and endograft migration after EVAR. These findings suggest that aortic curvature is a better parameter than angulation to predict post-EVAR failure and should be included as a hostile neck parameter.

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Section: Discussionmentioning

confidence: 85%

Section: Limitationsmentioning

confidence: 89%

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Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

et al. 2017

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“…We therefore propose to modify the previous risk-stratified surveillance protocol, because patients with increased risk may benefit from a timely second postoperative CTA scan. These high-risk patients include those with challenging pre-operative anatomy, such as short neck length (<10 mm), large neck diameter (>30 mm), large aortic curvature (>50 m −1 ), large aneurysm sac diameter (>65 mm), or large CIA diameter (>19 mm) [21][22][23][24][25][26], those treated outside indications for use [27], those with any endoleak or insufficient proximal or distal seal (<10 mm) on the first postoperative CTA [4,5], and those where suspicion of complications arises during follow-up, such as >5 mm aneurysm growth. In these patients, a second postoperative CTA is advised within 2 years, on which endograft apposition and position should be re-assessed and compared with the baseline values on the first postoperative CTA scan to allow detection of continuous (subtle) deterioration of apposition over time.…”

Section: Expert Opinionmentioning

confidence: 99%

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

Schuurmann

Rooy

Gonçalves³

et al. 2019

Expert Review of Medical Devices

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Introduction: Although there is much attention for proper sizing of pre-operative anatomy before (thoracic) endovascular aneurysm repair ([T]EVAR), standardized assessment of endograft position and apposition at postoperative imaging is seldom addressed in the international guidelines. The highly detailed three-dimensional computed tomography angiography (CTA) volumes contain valuable information about the apposition of the endograft with the arterial wall and the position of the device relative to anatomical landmarks in the proximal and distal landing zones, which is currently hardly used. With proper assessment on CTA of the endograft after EVAR, the risk for future endograft-related complications may be determined, allowing patient-tailored, risk-stratified surveillance. Areas covered: This systematic review identified three standardized methods for assessing apposition or position of the endograft in the proximal or distal landing zone on CTA after (T)EVAR. Quantification of apposition and position, validation of measurement precision, and association with endograft-related complications were extracted. Short (<10 mm apposition length) and decreasing (>0 mm) apposition were associated with endograft-associated complications. Expert commentary: Standardized assessment of apposition and position of the endograft in the proximal and distal landing zones on CTA should be incorporated in post-(T)EVAR surveillance. A riskstratified CTA surveillance protocol is proposed.

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“…Subsequently, the same authors reported that aortic curvature appeared to be the best predictor of intraoperative type Ia endoleak along with aortic neck calcification, whereas aortic neck angulation was not. 17…”

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confidence: 99%

Commentary: Preoperative Aortic Morphology Identifies Patients at High Risk for Late Failure of Endovascular Aneurysm Repair

et al. 2017

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Aortic curvature as a predictor of intraoperative type Ia endoleak

Cited by 26 publications

References 16 publications

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

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

Commentary: Preoperative Aortic Morphology Identifies Patients at High Risk for Late Failure of Endovascular Aneurysm Repair

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