Remodeling of abdominal aortic aneurysm sac following endovascular aortic repair: association with clinical, surgical, and genetic factors

D’Oria, Mario; Girolamo, Filippo Giorgio Di; Calvagna, Cristiano; Gorgatti, Filippo; Altamura, Nicola; Lepidi, Sandro; Biolo, Gianni; Fiotti, Nicola

doi:10.1016/j.carpath.2021.107405

Cited by 10 publications

(3 citation statements)

References 33 publications

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“…This may be explained by the fact that mechanical stress interacts with the patient’s aorta biomechanical properties that are influenced also by genetic and histopathologic factors. For instance, recent evidence has shown that matrix metalloproteinases, long known for their association with AAA incidence, are also linked to AAA sac behavior after EVAR [ 28 ]. Therefore, it would be reasonable to assume that they can also play an important role in the occurrence of PND over time and explain some of the differences observed.…”

Section: Discussionmentioning

confidence: 99%

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Mezzetto

D’Oria

Lepidi

et al. 2023

JCM

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Background: To define proximal neck dilation (PND) after standard endovascular aneurysm repair (EVAR) and fenestrated EVAR (FEVAR), determining: incidence and risk factors; evidence base that links PND to outcomes of patients; recurring themes or gaps in the literature. Methods: We performed a scoping review and included only full-text English articles with follow-up focusing on PND in patients undergoing EVAR or FEVAR, published between 2000 and 2022. The following PICO question was used to build the search equation: in patients with abdominal-aortic-aneurysm (AAA) (Population) undergoing endovascular repair (Intervention), what are the incidence, risk factors and prognosis of radiologically defined PND (Comparison) on short-term and long-term outcomes (Outcomes)? Results: 15 articles were included after review. Measurement protocols for proximal aortic neck (PAN) varied among individual studies and the definition of PND resulted as heterogeneous. Rate of patients with a PND ranged between 0% and 41%. Large proximal neck (>28 mm) and excessive graft sizing (30%) were predictors for PND. New endografts with low outward radial forces and FEVAR seemed to be protective. Surgical conversion was the definitive option in the case of patients unfit for other endovascular treatments. Conclusions: PND is a frequent finding after EVAR and FEVAR. Excessive graft oversizing and large baseline PAN were predictors of neck enlargement, independently by the type of standard endograft used. FEVAR may be considered protective against complications, together with endografts using low outward radial forces. Lifelong radiological follow-up is mandatory.

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Section: Discussionmentioning

confidence: 99%

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Mezzetto

D’Oria

Lepidi

et al. 2023

JCM

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“…Abdominal aortic aneurysm (AAA) is a specific form of atherothrombotic disease, which is usually characterized by dilated abdominal aorta greater than 30 mm or exceeding 50% the normal aortic diameter [ 1 ]. Endovascular repair, open surgery, and various medications such as statins, aspirin, and warfarin were used to slow the expansion rate and even regress sac volume [ 2 , 3 , 4 , 5 ]. However, the result of using the above methods for restricting the expansion rate on AAA was still uncertain.…”

Section: Introductionmentioning

confidence: 99%

Effect of Antiplatelet Agents on Abdominal Aortic Aneurysm Process: A Systematic Review and Meta-Analysis

Yang,

Li,

et al. 2023

Rev. Cardiovasc. Med.

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Background: This systematic review and meta-analysis aims to investigate whether antiplatelet agents are associated with the reduction, expansion, and rupture of abdominal aortic aneurysm (AAA). Methods: A thorough exploration was conducted on four prominent databases, namely EMBASE, Ovid, PubMed, and Scopus, to identify studies that reported the influence of antiplatelet agents on the sac development of AAA. The assessment was carried out until March 2023. R software v.4.1 was used for statistical analysis. Results: After reviewing 13 publications which included a total of 5392 patients (1446 in the antiplatelet group and 2540 in the control group), a meta-analysis was conducted. The results of the analysis revealed that there was no significant difference in the annual growth rate of AAA diameter between those who received antiplatelet agents and those who did not (mean difference (MD) = -0.04, 95% CI = [-0.37, 0.30]; heterogeneity: p < 0.01, I 2 = 91%, τ 2 = 0.1278). Additionally, there was no difference in the number of patients who experienced aneurysm diameter expansion between the two groups, significantly (odds ratio (OR) = 0.96, 95% CI = [0.41, 2.25]; heterogeneity: p < 0.01, I 2 = 78%, τ 2 = 0.5849). Conclusions: Antiplatelet agents do not affect AAA's reduction, expansion, or rupture. There is no benefit to AAA patients taking antiplatelet agents for the purpose of slowing down growth rates of sac diameter.

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“…[159] Furthermore, functional genetic polymorphisms of some matrix metalloproteases or of their natural inhibitors have been associated with AAA remodeling after endovascular treatment. [160] In an ideal world, geometric endograft and anatomic parameters automatically extracted from the postoperative CTA scan are combined and weighed by a prediction model. The outcome of the prediction model should be a report including all geometric parameters and a suggestion about the time interval for further imaging surveillance and the type of imaging modality.…”

Section: Postoperative Imaging Surveillancementioning

confidence: 99%

Geometric analysis of stent grafts to anticipate complications after endovascular aortic aneurysm repair

van der Riet

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Remodeling of abdominal aortic aneurysm sac following endovascular aortic repair: association with clinical, surgical, and genetic factors

Cited by 10 publications

References 33 publications

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Effect of Antiplatelet Agents on Abdominal Aortic Aneurysm Process: A Systematic Review and Meta-Analysis

Geometric analysis of stent grafts to anticipate complications after endovascular aortic aneurysm repair

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