Effect of type II endoleaks and antiplatelet therapy on abdominal aortic aneurysm shrinkage after endovascular repair

Aoki, Atsushi; Suezawa, Takanori; Sangawa, Kenji; Tago, Mamoru

doi:10.1016/j.jvs.2011.03.269

Cited by 42 publications

(31 citation statements)

References 23 publications

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“…We previously reported that only persistent type II endoleaks had a negative influence on diameter shrinkage after EVAR, 13 and other researchers also reported similar results. 14,15 Although the IFU of most commercially available stent grafts provide a PN angulation of Յ60°, according to the results from the present study, PN angulation was not a major issue in patients with AAAs with an adequate PN length. Of course, attention should be paid to a short, severely angulated neck, because such a neck has a risk for type Ia endoleak or obstruction of a renal artery by the upward movement of a stent graft after removing a stiff guidewire.…”

Section: Discussionsupporting

confidence: 52%

Remodeling of proximal neck angulation after endovascular aneurysm repair

Ishibashi

Ishiguchi

Ohta

et al. 2012

Journal of Vascular Surgery

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Section: Discussionsupporting

confidence: 52%

Remodeling of proximal neck angulation after endovascular aneurysm repair

Ishibashi

Ishiguchi

Ohta

et al. 2012

Journal of Vascular Surgery

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“…Our single institution study also revealed the presence of an endoleak and infrarenal neck angulation >60° as significant and independent predictors of sac expansion. In a study of 57 patients with AAA, Aoki et al (19) reported multi-agent antiplatelet therapy and type II endoleaks to be significantly associated with the absence of aneurysm shrinkage at six months after EVAR. They defined aneurysm shrinkage as a decrease in sac diameter of ≥4 mm.…”

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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“…Jones et al 8 reported that persistent T2E that remains for >6 months after EVAR poses a risk for aneurysm sac enlargement. Furthermore, Aoki et al 11 presented that T2E detected at 7 days and 6 months after EVAR was correlated with a lack of shrinkage. Based on this finding and the unique medical insurance system in our country that allows most patients to stay in the hospital longer than 1 week after EVAR, the first CT scan with contrast enhancement has been carried out on the seventh day after EVAR to evaluate T2E.…”

Section: Discussionmentioning

confidence: 99%

Postoperative initial 2-day blood pressure management facilitates the shrinkage of abdominal aortic aneurysm after endovascular aneurysm repair by reducing the incidence of type II endoleak

Miura

Kurimoto

Ujihira

et al. 2018

Journal of Vascular Surgery

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Effect of type II endoleaks and antiplatelet therapy on abdominal aortic aneurysm shrinkage after endovascular repair

Abstract: Patients with a persistent type II endoleak and patients undergoing multiagent antiplatelet therapy are at an increased risk of a lack of aneurysm shrinkage 6 months after EVAR.

Cited by 42 publications

References 23 publications

Remodeling of proximal neck angulation after endovascular aneurysm repair

Remodeling of proximal neck angulation after endovascular aneurysm repair

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

Postoperative initial 2-day blood pressure management facilitates the shrinkage of abdominal aortic aneurysm after endovascular aneurysm repair by reducing the incidence of type II endoleak

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