Changing Aneurysmal Morphology after Endovascular Grafting: Relation to Leakage or Persistent Perfusion

Abstract

Purpose: To relate changing abdominal aortic aneurysm (AAA) morphology after endovascular grafting to the presence of leakage, collateral perfusion, and other factors. Methods: Thirty-five patients who underwent successful AAA endovascular grafting were evaluated. Self-expanding Z-stents and Dacron grafts were applied in bifurcated and aortomonoiliac systems. Postoperative diameter changes were calculated from repeated spiral computed tomographic scans, angiograms, and ultrasonic phase-locked echo-tracking scans during a median 6-month follow-up (interquartile range [IQR] 3 to 12). Results: At 12 months, the diameters of completely excluded aneurysms had decreased 6 mm (IQR 2 to 11; p = 0.006). The proximal graft-anchoring stents had dilated 2 mm (IQR 0.5 to 3.3; p = 0.01). The aortic diameters immediately below the renal arteries but above the stents had not changed. Endoleakage and collateral perfusion (n = 13) were each associated with preserved aneurysm size and a 12 times higher risk of aneurysm dilation. After the leakage or the collateral perfusion had been treated, the aneurysm size decreased. Aneurysms with extensive intraluminal thrombi presented a reduced risk of leakage or perfusion. Conclusions: The diameters of endovascularly excluded AAAs decrease, except in cases of leakage or perfusion. Careful follow-up of patients with aortic endografts is necessary.

Leakages after Endovascular Repair of Aortic Aneurysms: Classification Based on Findings at CT, Angiography, and Radiography

“…According to reports in the literature (3,10,11), leakages as a complication of endovascular aneurysms of the abdominal aorta occur in 2.4%-45.5% of cases. Leakages may originate at both the proximal and distal ends of the graft; these are so-called perigraft leaks according to the classification of White et al (10,11).…”

“…The clinical importance of leakages remains unclear; however, some reports (2)(3)(4)(5) suggest that there is an increased risk of aneurysm rupture in association with them. Computed tomography (CT) is recognized as the most sensitive method of detecting leakages (6,7), but it often does not provide immediate evidence of their cause.…”

Evaluation of the proximal aortic neck enlargement following endovascular repair of abdominal aortic aneurysm: 3-years experience

“…The reported annual degree of neck enlargement is extremely variable: from <1 mm/year [10,14], to 1-2 mm/year [3,15,16] and over 2 mm/year [4,8,17]. There is an error of approximately 1-2 mm in the measurement procedure [3,7,18], and early neck dilatation is related to stent-graft oversizing [4,9].…”

Guidelines for the treatment of abdominal aortic aneurysms: Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery

“…While AAA sac maximal diameter shrinkage was initially received with enthusiasm, longer follow-up has demonstrated that this may be associated with later adverse effects upon the endograft including limb kinkage or occlusion, modular junctional separations, device migration, or related problems. [129][130][131] Such consequences of late morphologic changes to the AAA have been termed the "paradox of success." 117 Structural deterioration of endoluminal devices appears to increase with time and can also be a source of treatment failure.…”