Quantification of suprarenal aortic neck dilation after fenestrated endovascular aneurysm repair

Proximal seal dilatation following fenestrated endovascular repair for complex abdominal aortic aneurysms

“…Thus, our data do not yet provide enough information to suggest whether the existing common practice for oversizing should be altered. Although not significant, our results demonstrate a trend that wider preoperative proximal seal diameters are associated with increased risk of >10% PSD at one year, which is in conjunction with earlier findings for FEVAR 12,13,16 and standard infrarenal EVAR. 5 Such a relation was not visible in univariable analysis, which we believe is the result of the small variety in proximal seal diameter within the cohort, and as diameters differ greatly at different aortic levels.…”

“…The occurrence of PSD following FEVAR has been previously described by Tran et al in 43 FEVAR-patients. 13 Our study confirms the development of PSD at this aortic level with a larger sample size, but also demonstrated that proximal seal dilatation following FEVAR decelerates over time. The subsequent deceleration that we found is in concordance with previous studies on infrarenal EVAR 6 , and with Zetterval et al and Qaderi et al, who reported on proximal neck dilatation following FEVAR with physician modified endografts (PMEGs).…”

“…We found that increased stent-graft oversizing was associated with an additional risk of >10% PSD at one-year, confirming findings from previous reports that studied proximal seal dilatation in the visceral segment. 12,13,16 Furthermore, these findings matched the associations found for neck dilatation after standard infrarenal EVAR; as reported in a systematic review by Kouvelos et al 5 Although increased oversizing does seem to be associated with PSD, we do not know whether increased oversizing will eventually lead to adverse outcomes too. Thus, our data do not yet provide enough information to suggest whether the existing common practice for oversizing should be altered.…”

“…Variables for the model were selected a priori based on univariable outcomes and previous literature, including preoperative proximal seal diameter and stentgraft oversizing. 5,12,13 Rates of excessive dilatation over the course of 48 months were estimated by using Kaplan-Meier methods.…”

“…Alternative theories suggest that endografts J o u r n a l P r e -p r o o f may contribute to wall hypoxia, subsequently promoting neck degeneration. 13 Otherwise, the difference in overall dilatation at these two aortic levels could potentially be due to the fact that the covered portion is closer to a diseased part of the aortic wall, thus potentially leading to more wall degradation and dilatation.…”