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

Abstract

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...

Aneurysm sac expansion is independently associated with late mortality in patients treated with endovascular aneurysm repair

“…Whereas our rate of no identifiable endoleak among patients with sac expansion was high at 57%, other centers have also shown high rates ranging from 22% to 43%. 30–32 The reason for the discrepancy in our rate and the rate of others is perhaps because sac expansion in our cohort could have been defined on the basis of ultrasound alone, and it is unclear whether these patients underwent imaging that could have identified an endoleak, whereas in other studies, all patients underwent computed tomography imaging. Other potential explanations include the possibility of a methodologic error inherent in the VSGNE data set in which endoleaks are self-reported by participating centers without any core imaging laboratory adjudication.…”

Expert Opinion on Hostile Neck Definition in Endovascular Treatment of Abdominal Aortic Aneurysms (a Delphi Consensus)

“…Not surprisingly, highly angulated aortic necks have also been associated with higher rates of sac expansion, endograft migration, and endoleaks. 11,43 Moreover, according to most of EP members conical-shaped Fig. 2.…”

Late‐onset type I endoleak characterized by contrast enhanced ultrasound after endovascular repair of aortic aneurysm

“…Endoleaks are frequent after EVAR and have been shown to occur in 20% to 25% of case, and more commonly in the first two years following intervention . Preoperative risk factors for endoleak following EVAR include aneurysm length, increased infrarenal angulation at the aneurysm neck, large diameter patent collateral vessels, and increased age of the patient . Postoperative factors include increasing aneurysm size and the use of earlier generation devices…”