Aneurysm Volumes After Endovascular Repair of Ruptured vs Intact Aortic Aneurysms: A Retrospective Observational Study

Abstract

Purpose To compare changes in abdominal aortic aneurysm (AAA) sac volume between endovascular aneurysm repairs (EVAR) performed for ruptured (rEVAR) vs intact (iEVAR) AAAs and to determine the impact of early volume shrinkage on future complications. Materials and Methods A retrospective analysis was performed of all patients undergoing standard infrarenal EVAR from 2002 to 2016 at a tertiary referral institution. Only patients with degenerative AAAs and with 30-day and 1-year computed tomography angiography (CTA) imaging were included. Early sac shrinkage was defined as a volume sac reduction >10% between the first (<30-day) and the 1-year CTA. The primary endpoint was to compare AAA sac volume changes between patients undergoing rEVAR (n=51; mean age 71.0±8.5 years; 46 men) vs iEVAR (n=393; mean age 72.3±7.5 years; 350 men). Results are reported as the mean difference with the interquartile range (IQR Q1, Q3). The secondary endpoint was freedom from aneurysm-related complications after 1 year as determined by regression analysis; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results At baseline, the rEVAR group had larger aneurysms (p<0.001) and shorter (p<0.001) and more angulated (p=0.028) necks. Aneurysm sac volume decreased more in the rEVAR group during the first year [−26.3% (IQR −38.8%, −12.5%)] vs the iEVAR group [−11.9% (IQR −27.5%, 0); p<0.001]. However, after the first year, the change in sac volume was similar between the groups [−3.8% (IQR −32.9%, 31.9%) for rEVAR and −1.5% (IQR −20.9%, 13.6%) for iEVAR, p=0.74]. Endoleak occurrence during follow-up was similar between the groups. In the overall population, patients with early sac shrinkage had a lower incidence of complications after the 1-year examination (adjusted HR 0.59, 95% CI 0.39 to 0.89, p=0.01). Conclusion EVAR patients treated for rupture have more pronounced aneurysm sac shrinkage compared with iEVAR patients during the first year after EVAR. Patients presenting with early shrinkage are less likely to encounter late complications. These parameters may be considered when tailoring surveillance protocols.

Outcomes of Endurant II Stent Graft According to Anatomic Severity Grade Score

“…14,31,27 In this regard, the ASG score could help improve the selection of patients for follow-up and reduce follow-up costs because patients with low scores have low rates of implant-related complications and therefore do not need a strict follow-up like high-score patients. 32 A strength of the present study is that all cases had the same stent graft system, which makes the cohort on both groups of the ASG score homogenous. Nevertheless, this study has some limitations, including its single-institution retrospective design and the lack of randomization and clinical event committee.…”

Incidence and Risk Factors for Sac Expansion after Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms

“…However, comparative research of sac changes between ruptured and intact AAAs after EVAR has rarely been performed. One recent study showed that there was no difference in the sac behavior between ruptured and intact AAAs treated with EVAR from postoperative 1 year [ 30 ]. Based on this finding, we included patients with ruptured AAAs to reflect real-world data.…”

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

“…Or AAA sac volume can be used as an alternative method. 66,67 Effective oversizing (of the main body of the endograft regarding the post-operative aortic neck diameter):…”