Chronological Change of the Sac after Endovascular Aneurysm Repair

Abstract

Purpose:The purpose of this study was to evaluate the potential risk factors of type II endoleak and sac growth after endovascular aneurysm repair (EVAR) and the outcomes of secondary interventions.Materials and Methods:Ninety seven patients underwent elective EVAR for infrarenal abdominal aortic aneurysms in two tertiary centers between April 2005 and July 2013. Clinical and imaging parameters were compared among sac growth (>5 mm) and non-growth groups. Risk factors associated with sac growth and persistent type II endoleak were analyzed. The outcomes of reinterventions for persistent type II endoleak were determined.Results:Sac growth was observed in 20 cases (20.6%) and endoleak was found in 90% of them compared to 28.6% (22/77) in the non-growth group (P<0.001). The majority of endoleaks were type II (36/40) and 80.5% were persistent. Sac diameter, neck diameter and number of patent accessory arteries were also statistically significant for sac growth. On multivariate analysis, grade of calcification at the neck, grade of mural thrombus at the inferior mesenteric artery and number of patent accessory arteries were risk factors of persistent type II endoleak. Twenty six reinterventions were done for 16 patients with persistent type II endoleak, with a technical success rate of 88.5%, yet 55.5% showed sac growth regardless of technical success. There were no ruptures during the follow-up period.Conclusion:Sac growth after EVAR was mostly associated with persistent type II endoleak. Secondary interventions using transarterial embolization is partially effective in achieving clinical success.

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

“…Also, when the neck thrombus grade was expressed as the absolute degrees of neck thrombus circumference in a different population, a high degree was significantly more present in patients without AAA shrinkage (p=0.003) 19 . However, when scored 0-3 in another study, no significant association between the grade of AAA neck thrombus and AAA sac growth was found after a mean follow up of 45.8±23.3 months 26 . Thrombus thickness in the neck was not found to be significantly associated with AAA sac remodeling 19 .…”

“…In addition, it was concluded that the presence of hostile neck anatomy, infrarenal neck angulation, neck length, and patency of the IMA are not predictive of AAA sac remodeling after EVAR. Surprisingly, the patency of the IMA is not related to AAA sac remodeling even though the IMA is a common origin of persistent type II endoleaks, which has repeatedly been shown to correlate to AAA sac remodeling 7,26,35,36 .…”

“…The main findings of each study on the correlation of the anatomical parameter with AAA sac growth and shrinkage are presented in Table III [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . A total of 27 anatomical parameters were Preoperative neck thrombus was indicated to predict less AAA sac shrinkage after EVAR 19,24,26,33 . The presence of this neck thrombus was found to be predictive of less AAA shrinkage at 6, 12, and 24 months after EVAR in two independent studies (p<0.05) 19,33 .…”

Circulating biomarkers are not associated with endoleaks after endovascular repair of abdominal aortic aneurysms

“…6 Despite low perioperative morbidity and mortality, the durability of EVAR is of concern as a high proportion of patients have continued perfusion of the AAA sac or endoleak. [7][8][9] Endoleak is the most common complication of EVAR and may be due to incomplete seal of the proximal or distal end of the graft (type I endoleak), reverse flow through collateral arteries (type II endoleak), or stent defects (types III-V). 10,11 Patients undergoing EVAR require long-term monitoring involving computed tomography or ultrasound to detect endoleak.…”

Evolution and clinical relevance of common iliac artery seal zone after endovascular aortic aneurysm repair

“…Endovascular aortic aneurysms repair (EVAR) offers a less invasive alternative especially for patients with severe comorbidities deemed unfit or high risk for open surgery, 1,2 though long-term results are less inspiring due to late complications requiring reintervention. 3 There is plenty of data regarding the proximal neck changes, dilatation, and migration after EVAR; 4,5 however, the evidence on iliac evolution after implantation is scarce.…”