Pre-operative Aortic Neck Characteristics and Post-operative Sealing Zone as Predictors of Type 1a Endoleak and Migration After Endovascular Aneurysm Repair: A Systematic Review and Meta-Analysis

Zuidema, Roy; Riet, Claire van der; Moumni, Mostafa El; Schuurmann, Richte C. L.; Ünlü, Çağdaş; Vries, Jean‐Paul P.M. de

doi:10.1016/j.ejvs.2022.08.017

Cited by 8 publications

(3 citation statements)

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“…While performing the EVAR procedure, it is difficult to predict the incidence of ELIa due to its dependence on the patient's aortic anatomy and stent graft utilization. A hostile neck anatomy encompasses a spectrum of risk factors, and there is a scarcity of evidence specifying which configuration is the most prevalent cause of intraoperative ELIa [ 32 , 33 ]. Our study, with a small sample size, demonstrated that there was no difference in baseline patient characteristics or aortic neck morphology between the coiling and noncoiling groups, highlighting the benefit of the selective aneurysmal sac neck-targeted embolization technique in the case of intraoperative ELIa.…”

Section: Discussionmentioning

confidence: 99%

Selective aneurysmal sac neck-targeted embolization during endovascular repair of abdominal aortic aneurysm with hostile neck anatomy

Zhang,

Tang,

Wang

et al. 2024

J Cardiothorac Surg

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Purpose To evaluate the efficacy and safety of selective aneurysmal sac neck-targeted embolization in endovascular aneurysm repair (EVAR) in patients with a hostile neck anatomy (HNA). Materials and methods Between October 2020 and June 2022, patients with an abdominal aortic aneurysm (AAA) and HNA who underwent EVAR with a low-profile stent graft and a selective aneurysmal sac neck-targeted embolization technique were analysed. An HNA was defined by the presence of any of the following parameters: infrarenal neck angulation > 60°; neck length < 15 mm; conical neck; circumferential calcification ≥ 50%; or thrombus ≥ 50%. Before occluding the entire aneurysm during the procedure, a buddy wire was loaded prophylactically into the sac through the contralateral limb side. If a type Ia endoleak (ELIa) occurred and persisted despite adjunctive treatment such as balloon moulding or cuff extension, this preloaded wire could be utilized to enable a catheter to reach the space between the stent graft and sac neck to perform coil embolization. In the absence of ELIa, the wire was simply retracted. The primary outcome of this study was freedom from sac expansion and endoleak-related reintervention during the follow-up period; secondary outcomes included technical success and intraoperative and in-hospital postoperative complications. Results Among the 28 patients with a hostile neck morphology, 11 (39.5%) who presented with ELIa underwent intraprocedural treatment involving sac neck-targeted detachable coil embolization. Seventeen individuals (60.7%) of the total patient population did not undergo coiling. All patients in the coiling group underwent balloon moulding, and 2 patients additionally underwent cuff extension. In the noncoiling group, 14 individuals underwent balloon moulding as a treatment for ELIa, while 3 patients did not exhibit ELIa during the procedure. The coiling group showed longer operating durations (81.27 ± 11.61 vs. 70.71 ± 7.17 min, P < 0.01) and greater contrast utilization than the noncoiling group (177.45 ± 52.41 vs. 108.24 ± 17.49 ml, P < 0.01). In the entire cohort, the technical success rate was 100%, and there were no procedure-related complications. At a mean follow-up of 18.6 ± 5.2 months (range 12–31), there were no cases of sac expansion (19 cases of sac regression, 67.86%; 9 cases of stability, 32.14%) or endoleak-related reintervention. Conclusions Selective aneurysmal sac neck-targeted embolization for the treatment of ELIa in AAA patients with an HNA undergoing EVAR is safe and may prevent type Ia endoleak and related sac expansion after EVAR.

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Section: Discussionmentioning

confidence: 99%

Selective aneurysmal sac neck-targeted embolization during endovascular repair of abdominal aortic aneurysm with hostile neck anatomy

Zhang,

Tang,

Wang

et al. 2024

J Cardiothorac Surg

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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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“…Notably, type I endoleaks are associated with higher rupture risk (4%-7.5% at 2 years) and late conversion to open repair . Risk factors for type I endoleaks are primarily related to the anatomy of the aorta at the time of repair, including a short, angulated, or reverse tapered aneurysmal neck, large AAA diameter, mural neck thrombus, or calcification . Further, large infrarenal neck diameters (≥30 mm) require 34- to 36-mm endografts and are increasingly recognized to be a risk factor for type IA endoleaks and stent migration .…”

Section: Type I Endoleaksmentioning

confidence: 99%

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

et al. 2023

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ImportanceEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms, encompassing 80% of all repairs in the United States. Endoleaks are ubiquitous and affect 30% of patients treated by EVAR, potentially leading to sac enlargement and increased risk of rupture. The care of EVAR patients requires long-term surveillance by a multidisciplinary team. Accordingly, physicians should be familiar with the fundamentals of endoleak management to achieve optimal outcomes, including timely referral for remediation or providing counseling and reassurance when needed.ObservationsPubMed and the Cochrane database were searched for articles published between January 2002 and December 2022 in English, addressing epidemiology, diagnosis, and management of endoleaks after EVAR. Endoleaks can be detected intraoperatively or years later, making lifelong surveillance mandatory. Type I and III have the highest risk of rupture (7.5% at 2 years and 8.9% at 1 year, respectively) and should be treated when identified. Intervention should be considered for other types of endoleak when associated with aneurysm sac growth larger than 5 mm based on current guidelines. Type II endoleaks are the most common, accounting for 50% of all endoleaks. Up to 90% of type II endoleaks resolve spontaneously or are not associated with sac enlargement, requiring only observation. Although the risk of rupture is less than 1%, cases that require reintervention are challenging. Recurrence is common despite endovascular treatment, and rupture can occur without evidence of sac growth. Type IV endoleaks and endotension are uncommon, are typically benign, and primarily should be observed.Conclusions and RelevanceEndoleak management depends on the type and presence of sac expansion. Type I and III endoleaks require intervention. Type II endoleaks should be observed and treated selectively in patients with significant sac expansion. Since endoleaks can appear any time after EVAR, at least 1 contrast-enhanced computed tomographic angiogram or duplex ultrasound by an experienced laboratory is recommended every 5 years.

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Pre-operative Aortic Neck Characteristics and Post-operative Sealing Zone as Predictors of Type 1a Endoleak and Migration After Endovascular Aneurysm Repair: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 61 publications

Selective aneurysmal sac neck-targeted embolization during endovascular repair of abdominal aortic aneurysm with hostile neck anatomy

Selective aneurysmal sac neck-targeted embolization during endovascular repair of abdominal aortic aneurysm with hostile neck anatomy

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

Management of Endoleaks After Elective Infrarenal Aortic Endovascular Aneurysm Repair

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