Post-EVAR aneurysm sac shrinkage is prognostically favorable, but does not justify withholding follow-up

Langenberg, Jasper C M; Roijers, Joost P.; Ho, Gwan H.; Veen, Eelco J.; Vos, Douwe; Buimer, Thijs M.G.; Groot, H.G. de; Laan, L. van der

doi:10.23736/s0021-9509.18.10584-2

Cited by 6 publications

(12 citation statements)

References 26 publications

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“…The search of electronic databases and reference lists of relevant articles identified 8 studies in 9 publications 12–20 that met the criteria for this analysis. The studies reported a total of 17,096 patients: 8,518 patients with sac shrinkage and 8,578 patients without sac shrinkage.…”

Section: Resultsmentioning

confidence: 99%

“…The pooled incidence of aneurysm sac shrinkage during follow-up was 47% (95% CI 41% to 52%). Three of the studies 12–14 were conducted in the United States, 4 studies 17–20 in Europe (Netherlands, Sweden, France and Italy), and another 16 in Japan. All studies were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…All studies were retrospective. Four studies 12,17,18,20 were single-center, 2 studies 16,19 were multicenter, and another 2 studies 13,14 were national registries. The studies were published between 2013 and 2019, and the period during which the index EVAR was performed spanned from 1997 to 2018.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies 13,14,16,19 assessed aneurysm sac shrinkage 6 to 18 months following EVAR and then stratified patients into shrinkage and no shrinkage groups; the pooled incidence of sac shrinkage in these studies was 48% (95% CI 40% to 56%). In the remaining 4 studies, 12,17,18,20 stratification was based on whether sac shrinkage was noted at any time during the follow-up period after EVAR. Four studies 12,16,18,20 explicitly reported that they used CT for aneurysm sac measurements, another 2 17,19 used CT or ultrasonography, and the remaining 2 studies 13,14 provided no relevant information.…”

Section: Resultsmentioning

confidence: 99%

“…In the remaining 4 studies, 12,17,18,20 stratification was based on whether sac shrinkage was noted at any time during the follow-up period after EVAR. Four studies 12,16,18,20 explicitly reported that they used CT for aneurysm sac measurements, another 2 17,19 used CT or ultrasonography, and the remaining 2 studies 13,14 provided no relevant information. Six studies 12–14,16,19,20 defined sac shrinkage as reduction in aneurysm sac diameter ≥5 mm; the remaining 2 studies 17,18 defined sac shrinkage as reduction in sac diameter of ≥10 mm.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic Significance of Aneurysm Sac Shrinkage After Endovascular Aneurysm Repair

et al. 2020

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Purpose: To investigate whether patients who develop aneurysm sac shrinkage following endovascular aneurysm repair (EVAR) have better outcomes than patients with a stable or increased aneurysm sac. Materials and Methods: The Healthcare Databases Advanced Search interface developed by the National Institute for Health and Care Excellence was used to interrogate MEDLINE and EMBASE. Thesaurus headings were adapted accordingly. Case-control studies were identified comparing outcomes in patients demonstrating aneurysm sac shrinkage after EVAR with those of patients with a stable or expanded aneurysm sac. Pooled estimates of dichotomous outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Meta-analysis of time-to-event data was conducted using the inverse-variance method; the results are reported as a summary hazard ratio (HR) and 95% CI. Summary outcome estimates were calculated using random-effects models. Results: Eight studies were included in quantitative synthesis reporting a total of 17,096 patients (8518 patients with sac shrinkage and 8578 patients without sac shrinkage). The pooled incidence of sac shrinkage at 12 months was 48% (95% CI 40% to 56%). Patients with aneurysm sac shrinkage had a significantly lower hazard of death (HR 0.73, 95% CI 0.60 to 0.87), secondary interventions (HR 0.42, 95% CI 0.29 to 0.62), and late complications (HR 0.37, 95% CI 0.24 to 0.56) than patients with a stable or increased aneurysm sac. Furthermore, their odds of rupture were significantly lower than those in patients without shrinkage (OR 0.09, 95% CI 0.02 to 0.36). Conclusion: Sac regression is correlated to improved survival and a reduced rate of secondary interventions and EVAR-related complications. The prognostic significance of sac regression should be considered in surveillance strategies. Intensified surveillance should be applied in patients who fail to achieve sac regression following EVAR.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prognostic Significance of Aneurysm Sac Shrinkage After Endovascular Aneurysm Repair

et al. 2020

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Correlative effect between sac regression and clinical outcomes following endovascular repair in abdominal aortic aneurysm: fact or myth?

Al-Tawil,

Muscogliati,

Jubouri

et al. 2023

Expert Review of Medical Devices

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Endovascular Aortic Repair With the E-Tegra Device: Preliminary Outcomes From a Multicenter National Registry

Marone,

Rinaldi,

Brioschi

et al. 2024

J Endovasc Ther

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Purpose: Endovascular aortic repair (EVAR) is currently expanding its feasibility thanks to design innovations, but hostile proximal necks and narrow iliac arteries are still a constraint, as expressed by the Instructions for Use (IFU) of most devices. Our aim is to report the preliminary results of the E-Tegra endograft in infrarenal abdominal aortic aneurysms (AAAs) performed in 15 high-volume centers. Materials and Methods: The e-Tegra Italian endoGraft REgistry (TIGRE) is a prospectively maintained database of consecutive EVAR with the E-Tegra stent-graft across 15 participating centers between March 2021 and March 2023. The registry records baseline clinical data, anatomic measurements of the abdominal aorta, perioperative and postoperative outcomes, with a scheduled follow-up period of 3 years for all patients. This is a preliminary analysis of the first results updated to January 2024. The primary endpoints are technical and clinical success, perioperative mortality, freedom from endograft rupture, and aortic-related mortality. The secondary endpoints are freedom from reintervention, and any type of endoleak (EL). The results were analyzed in relation with the anatomic characteristics of the AAAs, namely, iliac axes tortuosity and proximal neck hostility. Results: The registry included 147 consecutive EVAR (138 elective and 9 in emergent setting), 7 of which were associated with an iliac branch implantation. Ninety patients had at least 1 criterion of anatomical hostility, and 25 were treated outside the device IFU. Primary technical success was achieved in 146 cases (99.3%) and assisted success in 147 (100%), with no perioperative mortality. After a median follow-up period of 20 months, no aneurysm-related mortality occurred. Reinterventions were 5: 2 for type IB EL and 3 for type II ELs with aneurysm sac increase. Five more type II ELs with aneurysm sac stability are under observation. No differences in terms of reinterventions were noted between aneurysms with standard and hostile anatomy. Conclusion: The E-Tegra endograft is safe and effective in treating AAAs with standard and hostile anatomy, with a low rate of complications and reinterventions, although longer-term outcomes and larger numbers are needed to compare its performances related to specific anatomic criteria. Clinical Impact This multi-center nationwide Registry reports a real-world experience of EVAR performed with the E-Tegra abdominal endograft across 15 high-volume Centers, providing early- and mid-term device-specific results, which will help vascular surgeons in endograft selection. In particular, this study focuses on clinical results obtained in treating aneurysms with hostile anatomy, analyzing the performances of the E-Tegra endograft in cases of hostile proximal necks and narrow or tortuous iliac axes.

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Post-EVAR aneurysm sac shrinkage is prognostically favorable, but does not justify withholding follow-up

Cited by 6 publications

References 26 publications

Prognostic Significance of Aneurysm Sac Shrinkage After Endovascular Aneurysm Repair

Prognostic Significance of Aneurysm Sac Shrinkage After Endovascular Aneurysm Repair

Correlative effect between sac regression and clinical outcomes following endovascular repair in abdominal aortic aneurysm: fact or myth?

Endovascular Aortic Repair With the E-Tegra Device: Preliminary Outcomes From a Multicenter National Registry

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