Volume regression of abdominal aortic aneurysms and its relation to successful endoluminal exclusion

Lee, Jason T.; Aziz, Ihab; Lee, James T.; Haukoos, Jason S.; Donayre, Carlos E.; Walot, Irwin; Kopchok, George E.; Lippmann, Mauricio; White, Rodney A.

doi:10.1016/s0741-5214(03)00924-8

Cited by 101 publications

(56 citation statements)

References 46 publications

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“…Furthermore, several potentially important variables, including inferior mesenteric artery and lumbar artery diameter (28), and neck calcification were not included in the analyses. Another limitation is that AAA volume may be a more accurate predictor than diameter for sac expansion or regression after EVAR and may have been more appropriate as an objective standard (29). However, it is very difficult and labor-intensive to analyze thin-slice CT images obtained at each follow-up using a dedicated three-dimensional workstation to provide reliable results, and to measure the sac volume at each follow-up.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…The dimensional evolution of the aneurysmal sac is the primary prognostic factor in these patients: a stable or shrinking aneurysm is associated with a low risk of rupture, even if associated with a small type II endoleak. On the contrary, an increasing sac is associated with a higher risk of rupture, and treatment is mandatory [14][15][16][17][18][19]. …”

Section: Discussionmentioning

confidence: 99%

“…Secondo i principali protocolli di sorveglianza, il follow-up dei pazienti sottoposti ad EVAR prevede un esame angio-TC a 1-3 mesi dal posizionamento dell'endoprotesi e successivamente, in assenza di complicanze, con scadenza annuale [8,[10][11][12][13]. Dopo EVAR, gli aneurismi che rimangono stabili o diminuiscono di dimensioni presentano un ridotto rischio di rottura e non richiedono ulteriori interventi anche in presenza di piccoli endoleaks [14][15][16][17][18][19]. L'analisi volumetrica della sacca è una misura più accurata della variazioni dimensionali dell'aneurisma rispetto alle misure lineari comunemente utilizzate [14,15,[20][21][22].…”

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“…Dopo EVAR, gli aneurismi che rimangono stabili o diminuiscono di dimensioni presentano un ridotto rischio di rottura e non richiedono ulteriori interventi anche in presenza di piccoli endoleaks [14][15][16][17][18][19]. L'analisi volumetrica della sacca è una misura più accurata della variazioni dimensionali dell'aneurisma rispetto alle misure lineari comunemente utilizzate [14,15,[20][21][22].…”

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Volumetric analysis of the aneurysmal sac with computed tomography in the follow-up of abdominal aortic aneurysms after endovascular treatment

et al. 2011

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“…In consideration of aortic kinking and irregular aneurysm morphology, diameter should be measured on multi-planar images. Three-dimensional reconstruc- tions and volumetric measurements are helpful in certain patients who do not show aneurysm regression [35,36].…”

Section: Diameter Measurementmentioning

confidence: 99%

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

et al. 2009

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Purpose: Endovascular aneurysm repair of the infrarenal or thoracic aorta has been shown to be a less invasive alternative to open surgery. A combined aneurysm of the thoracic and abdominal aorta is complex and challenging; the involvement of renal and/or visceral branches requires new treatment methods. Methods: A hybrid approach is currently an accepted alternative to conventional surgery. Renal and/or visceral revascularisation enables subsequent stent-graft placement into the visceral portion of the aorta. Results: Knowledge of the surgical procedure and a precise assessment of the vascular morphology are crucial for pre-procedural planning and for detection of post-procedural complications. Multi-detector computed tomography angiography (MDCTA) combined with two-and threedimensional (2D and 3D) rendering is useful for pre-interventional planning and for the detection of postprocedural complications. Threedimensional rendering allows proper anatomical analyses, influencing interventional strategies and resulting in a better outcome. Conclusions: With the knowledge of procedurespecific MDCTA findings in various vascular conditions, the radiologist and surgeon are able to perform an efficient pre-interventional planning and follow-up examination. Based on our experience with this novel technique of combined open and endovascular aortic aneurysm treatment, this pictorial review illustrates procedure-specific imaging findings, including common and rare complications, with respect to 2D and 3D post-processing techniques.

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Volume regression of abdominal aortic aneurysms and its relation to successful endoluminal exclusion

Cited by 101 publications

References 46 publications

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

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

Volumetric analysis of the aneurysmal sac with computed tomography in the follow-up of abdominal aortic aneurysms after endovascular treatment

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

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