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Objective: The purpose of this study was to identify the effect of abdominal aortic aneurysm (AAA) size on endoleak development and secondary intervention after endovascular repair (EVAR), as well as to examine the effect on overall survival and cause of mortality. Methods: Retrospective analysis was performed on all non-ruptured AAA treated by elective EVAR using FDA-approved endografts in our facility from July 2004 to December 2017. Patients were grouped into 3 cohorts based on preoperative aneurysm size: Group I (<5.5 cm), Group II (5.5-6.4 cm), and Group III (≥ 6.5 cm). Occurrences of endoleak, secondary intervention and overall survival underwent univariate and multivariate analysis. Cause of death data on deceased patients was similarly examined. Results: A total of 517 patients were analyzed. There was no difference between size groups in the rate of endoleak (Group I 48/277, 17.3%; Group II 33/160, 20.6%; Group III 18/80, 22.5%; p = 0.46) or time until endoleak development. Univariate analysis showed no difference in the rate of secondary intervention (Group I 36/277, 13.0%; Group II 24/160, 15.0%; Group III 18/80, 22.5%; p = 0.11), time until intervention or number of interventions performed. Multivariate analysis showed an association with shorter time to secondary intervention for both Group III aneurysms (HR 2.03, 95% CI 1.11-3.73; p = 0.02) and female patients (HR 1.79, 95% CI 1.02-3.13; p = 0.04). There was no difference in overall survival, aneurysm-related mortality or overall cause of mortality. Conclusion: AAA diameter prior to EVAR was not associated with any differences in rates of endoleak or secondary intervention, and was not associated with poorer overall survival or greater aneurysm-related mortality. Patients with suitable anatomy for EVAR can be considered for this intervention without concern for increased complications or poorer outcomes related to large aneurysm diameter alone.

RationaleThe purpose of this study was to investigate whether the proximity in anatomical locations of the Achilles (AT) and plantaris (PT) tendons promotes histopathological changes common to both tendons and their shared paratenon. The Achilles and plantaris tendons (ATs and PTs, respectively) share close anatomical locations in the foreleg, which has led to a proposed association between pathological findings in these tendons. Previous studies have identified such an association in specimens with known tendinopathy. This study aimed to determine whether similar correlation could be found in a group of cadavers without any record of tendon pathology.Materials and methodsThe subjects in this study were 20 donor cadavers (11 females and nine males) fixated in formalin, provided by the Department of Anatomy at Midwestern University. The mean age was 81 (±12). Twenty left, and 19 right legs were dissected. The ATs and PTs were assessed based on their gross anatomical characteristics, then samples of the tendons were harvested from two sites, one where the ATs and PTs ran closely together and a second where the PT was unassociated with the AT. The collected specimens were fixed, processed for paraffin embedding, sectioned, and stained with hematoxylin and eosin for histological analysis. Tissues were examined for the presence of inflammatory cells and for the evidence of stress‐induced conversion of the tendons’ dense connective tissue into fibrocartilage.ResultsIn four specimens (10.2%) the ATs and PTs ran separately, in eight (20.5%) specimens they were fused, and in three specimens the plantaris muscle was absent (7.7%). In the rest of the specimens the ATs and PTs were closely associated, but not fused. Histologically, no distinct evidence of inflammation was found at either the related or unrelated AT and PT sites. A presence of fibrocartilage with chondrocytes within the AT was noted in six (15.4%) specimens.ConclusionThe results of this study did not demonstrate any significant histopathologic changes in the areas of close contact between the ATs and PTs. The presence of fibrocartilage in the Achilles but not in the plantaris tendons suggests that the AT may be more affected by compression‐induced stress than the PT. These findings suggest that within the control group, close contact between AT and PT does not result in interrelated histopathologic changes. However, it is possible that histopathology may be observed in patients with mid‐portion Achilles tendinopathy.Support or Funding InformationZachary Belford and Benjamin Ferrel were supported by the Midwestern University Research Fellowship Program. Eric Leland and Andrew Cheung were supported by the Midwestern University work‐study program.