PC038. Influence of Infrarenal Oversizing of Aortic Stent Grafts on Patient Outcomes

Beckerman, William E.; Tadros, Rami O.; Sher, Alex; Power, John R.; Png, C.Y. Maximilian; Tardiff, Melissa; Marin, Michael L.; Faries, Peter L.

doi:10.1016/j.jvs.2016.03.279

Cited by 1 publication

(2 citation statements)

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“…Pitton et al showed strong results after 10-year follow-up with 20-25% oversizing of proximal diameters and 10-15% oversizing distally [73]. Similarly, in a recent study, 351 patients (mean outer-to-outer wall oversizing 17.7 ± 10.7%) from 2003 to 2014 showed that >20% oversizing was associated with decreased rates of endoleaks (all) compared with 10-20% oversizing, with the lowest rates in patients oversized 20-25% [58]. Interestingly, larger infrarenal neck diameters were associated with less oversizing.…”

Section: Recent Sizing Our Experience Conclusionmentioning

confidence: 82%

“…One such study of 2146 patients undergoing EVAR with multiple device types, showed a decreased risk of proximal endoleak starting at 10% oversizing with narrow confidence intervals up to 25% [14]. In another study, oversizing >20% was associated with fewer endoleaks (all) and less aneurysm sac enlargement, with the lowest rate of endoleaks occurring between 20 and 25% [58]. A mechanics study had similar findings suggesting that oversizing 20% helps prevent the occurrence of type I endoleaks [57].…”

Section: Endoleakmentioning

confidence: 89%

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Endograft Sizing for Abdominal Aortic Aneurysms

Sher¹,

Tadros²

2017

Aortic Aneurysm

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While a tight seal and fixation of aortic stent-grafts to the vessel wall are vital for positive outcomes in treating abdominal aortic aneurysms (AAAs), optimal aortic stent-graft sizing for endovascular aneurysm repair (EVAR) remains debatable. We performed a holistic review of the data surrounding the sizing of endografts using instructions for use (IFU) guidelines, as well as experimental, computational, and clinical studies. Most clinical studies that have investigated the role of sizing and outcomes are limited by the strict selection criteria, or the inability to account for the multitude of confounders associated with sizing. Currently, oversizing of endografts between 10 and 20% remains safe and favored, but sizing outside the IFU guidelines frequently occurs. Oversizing up to 25% appears to be associated with decreased rates of proximal endoleak and aneurysm sac enlargement, while excessive oversizing (>30%) has been linked to graft infolding, collapse, and aortic dilatation. It is unclear, however, whether there is an association between oversizing associated with neck dilatation and graft migration. During sizing, surgeons should take an individual approach and consider several factors including device type, calcification and/or thrombus of apposition site, hemodynamics, and aortoiliac morphology.

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Section: Recent Sizing Our Experience Conclusionmentioning

confidence: 82%