Volumetric analysis of the aneurysmal sac with computed tomography in the follow-up of abdominal aortic aneurysms after endovascular treatment

Abstract

CT volume analysis is an accurate and reproducible modality for the follow-up of abdominal aortic aneurysms after EVAR. At early follow-up, contrast-enhanced CT remains mandatory to identify small endoleaks. For later follow-up, volumetric analysis would eliminate the need for contrast material in asymptomatic patients with stable or decreasing aneurysm volume.

Impact of contrast injection and stent-graft implantation on reproducibility of volume measurements in semiautomated segmentation of abdominal aortic aneurysm on computed tomography

“…For some patients, measurement of AAA volume is more sensitive than diameter measurements in detecting subtle changes in AAA size [9][10][11][12]. Investigators have suggested different ways to implement AAA volume measurement in the followup of patients after EVAR [7][8][9][13][14][15].…”

Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion

“…The pEL2 are known to be associated with AAA expansion in about 70% of cases after 5 years of FU, which can be interpreted as a surrogate for continued risk of rupture. 12 , 13 , 21 – 24 Interestingly, although AAA expansion has been reported frequently in the presence of pEL2, increased rates of secondary ruptures and increased AAA-related mortality are scarcely reported in the literature. 24 , 25 , 13 To further complicate the decision-making process in clinical practice, reinterventions for EL2 can be technically challenging with only moderate clinical success rates on the patients’ side and a financial burden on the public health side.…”

“…These results are in line with previous studies and demonstrate a well-selected patient cohort, with strict thresholds for the declaration of AAA expansion and according to interobserver-validated measurements that pEL2 is associated with AAA expansion over time. 4 , 5 , 12 , 13 , 21 , 22 To address confounding factors that influence AAA expansion following EVAR, the groups under investigation in this study were matched for age and gender, which are two known factors that influence the rate of sac expansion. Furthermore, the groups were also comparable in key anatomic criteria, namely, AAA neck morphology and AAA diameter, which also represent factors that are known to be associated with a higher risk of AAA expansion.…”

“…The median maximum AAA diameter in the pEL2 group was 55 mm and the median AAA neck length was 35 mm (17-65) with a AAA neck diameter of 24 mm (16-32) and a neck angulation of 35° (5-97). The control group had a median maximum AAA diameter of 55 mm (46-87) with a median neck length of 32 mm (10-45), a median neck diameter of 25 mm (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), and an angulation of 36° (7-83). There were no statistically significant differences in preoperative AAA morphological characteristics between groups.…”