Early Changes in Abdominal Aortic Aneurysm Diameter after Endovascular Repair

Farner, Michael C.; Carpenter, Jeffrey P.; Baum, Richard A.; Fairman, Ronald M.

doi:10.1097/01.rvi.0000058322.82956.ad

Cited by 32 publications

(14 citation statements)

References 10 publications

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“…CT 114 Solis et al 28 2002 Aggressive identification and treatment 18·2 CT 191 Sampram et al 29 2003 Increase in sac diameter 12·2(11·7) CT 703 Faries et al 30 2003 n.s. 24·5(12·2) CT 597 Farner et al 31 2003 n.s. 12(2·4) CT 63 Kasirajan et al 32 2003 Aggressive identification and treatment 9(3·2) CT 104 Zarins et al 33 2004 n.s.…”

Section: Resultsmentioning

confidence: 99%

Type II endoleak after endovascular aneurysm repair

Sidloff

Stather

Choke

et al. 2013

British Journal of Surgery

241

196

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Section: Resultsmentioning

confidence: 99%

Type II endoleak after endovascular aneurysm repair

Sidloff

Stather

Choke

et al. 2013

British Journal of Surgery

241

196

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“…Although most aneurysmal sacs shrink after EVAR, some sacs continue to expand. A relationship between aneurysm size and endoleaks was previously reported (1,2). Most type II endoleaks spontaneously disappear over time, but 10%-25% persist for more than six months after EVAR (3)(4)(5)(6).…”

mentioning

confidence: 90%

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Nakaï

Ikoma²,

Sato³

et al. 2015

Diagn Interv Radiol

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Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair CARDIOVASCULAR IMAGINGORIGINAL ARTICLE PURPOSE We aimed to identify the risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair (EVAR). METHODSWe retrospectively reviewed contrast-enhanced computed tomography (CT) images of 143 patients who were followed for ≥6 months after EVAR. Sac expansion was defined as an increase in sac diameter of 5 mm relative to the preoperative diameter. Univariate and multivariate analyses were performed to identify associated risk factors for late sac expansion after EVAR from the following variables: age, gender, device, endoleak, antiplatelet therapy, internal iliac artery embolization, and preprocedural variables (aneurysm diameter, proximal neck diameter, proximal neck length, suprarenal neck angulation, and infrarenal neck angulation). RESULTSUnivariate analysis revealed female gender, endoleak, aneurysm diameter ≥60 mm, suprarenal neck angulation >45°, and infrarenal neck angulation >60° as factors associated with sac expansion. Multivariate analysis revealed endoleak, aneurysm diameter ≥60 mm, and infrarenal neck angulation >60° as independent predictors of sac expansion (P < 0.05, for all). CONCLUSIONOur results suggest that patients with small abdominal aortic aneurysms (<60 mm) and infrarenal neck angulation ≤60° are more favorable candidates for EVAR. Intraprocedural treatments, such as prophylactic embolization of aortic branches or intrasac embolization, may reduce the risk of sac expansion in patients with larger abdominal aortic aneurysms or greater infrarenal neck angulation.T he aim of endovascular abdominal aortic aneurysm repair (EVAR) is to prevent rupture of an abdominal aortic aneurysm (AAA) by depressurizing the aneurysm and excluding it from the systemic circulation using a stent-graft. Aneurysmal sac reduction is a reliable marker for the long-term prognosis after EVAR. Although most aneurysmal sacs shrink after EVAR, some sacs continue to expand. A relationship between aneurysm size and endoleaks was previously reported (1, 2). Most type II endoleaks spontaneously disappear over time, but 10%-25% persist for more than six months after EVAR (3-6). Persistent endoleaks with aneurysmal sac expansion are at high risk of rupture because of the continuously elevated intra-aneurysmal pressure and require a second intervention, such as embolization (7-11). However, it is difficult to predict sac expansion and persistent endoleak before performing EVAR. Although intraoperative intrasac thrombin injection and prophylactic embolization of aortic branches such as the inferior mesenteric artery and lumbar artery are reported to reduce the incidence of type II endoleak, the efficacy and clinical benefit of these procedures in terms of late postoperative aneurysm shrinkage have not been fully evaluated (12)(13)(14)(15). Therefore, the purpose of this study was to identify the risk factors associated with late...

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“…Aneurysms may, however, increase in diameter despite radiological resolution of the endoleak, as seen in two of the patients in the present study, or may rupture following a reduction in size 27 . The evolving concept of endotension 13−17 may further guide future management, but until non‐invasive methods for measuring aneurysm sac pressure are developed, increase in aneurysm sac size must remain the major guide to sac pressurization.…”

Section: Discussionmentioning

confidence: 68%

“…Endoleaks represent a persistence of flow into the aneurysm sac, but the sac pressure and risk of rupture are not easily elucidated, and will vary depending on the size and type of leak. Other factors may also contribute to sac pressurization, such as the relatively new concept of endotension 13−17 , in which pressure may be transmitted through intrasac thrombus.…”

Section: Introductionmentioning

confidence: 99%