Effect of Stentgraft Model on Aneurysm Shrinkage in 1,450 Endovascular Aortic Repairs

Abstract

Aneurysm diameter shrinkage can be achieved in most current EVARs with persisting effect at 10 years from repair and indicates the benefit and safety of treatment. Last generation devices seem to be important factors in inducing aneurysm sac shrinkage with similar clinically relevant effects among single models.

Durability of the Endurant stent graft in patients undergoing endovascular abdominal aortic aneurysm repair

“…This was also confirmed in our study, where the median survival time of patients with aneurysm shrinkage >5 mm was 8 months longer (P < .0001). In contrast to our study, Cieri et al 15 found lower but still comparable rates of aneurysm shrinkage of 40% (33 of 83 patients) in the Endurant group. However, their study did not report the exact follow-up time in patients receiving this specific device.…”

“…Currently, Cieri et al 15 In our analysis, implantation against IFU or peripheral vascular disease could not be identified as risk factors for limb occlusion. Our hypothesis for this complication is that the distal end of the iliac limbs is not always in an optimal apposition to the vessel wall of a tortuous or heavily calcified iliac artery, causing a form of high-grade stenosis or local vessel damage with intimal hyperplasia.…”

“…Similar trends were also observed in the randomized trials as well as in most retrospective studies. [1][2][3]15,16 In contrast to the randomized trials, we report no device-related deaths and only one AAA-related death caused by unsuccessful stent graft implantation. Nevertheless, the survival rates are very encouraging considering that we have included all consecutive patients, including many multimorbid patients unfit for open repair.…”

Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair

“…The importance of sac shrinkage has been investigated previously, and contraction of the aneurysm sac has been suggested as a marker for success after EVAR. In a recent publication involving 1450 procedures, Cieri and colleagues reported that persistent shrinkage of the AAA sac (over 5 mm) was associated with rates of freedom from AAA‐related death at 3 and 10 years of 100 and 99·7 per cent respectively. Houbballah and co‐workers reported no postimplant ruptures or conversions, and very low rates of type I leak (2·2 per cent) and secondary intervention (3·3 per cent) at a mean follow‐up of 4·2 years, for patients with significant sac contraction.…”

Type II endoleak is an enigmatic and unpredictable marker of worse outcome after endovascular aneurysm repair

“…Devices were defined as "new generation" if introduced after 2004 and currently in use. 5 After EVAR, patients were scheduled for serial followup imaging with duplex ultrasound and computed tomography angiography (CTA) scan at 1 month, 6 months, and yearly thereafter. Postoperative surveillance was performed using multiphasic CTA with 3-mm cuts, including imaging before the administration of contrast material, after the intravenous administration of contrast material in the arterial phase (arterial phase), and in postcontrast delayed phase (venous phase).…”