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    Predictors of Abdominal Aortic Aneurysm Sac Enlargement After Endovascular Repair

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    Authors
    Schanzer, Andres
    Greenberg, Roy K.
    Hevelone, Nathanael
    Robinson, William P. III
    Eslami, Mohammad H.
    Goldberg, Robert J.
    Messina, Louis M.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2011-04-12
    Keywords
    Aortic Aneurysm, Abdominal
    Endovascular Procedures
    Surgery
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1161/CIRCULATIONAHA.110.014902
    Abstract
    Background- The majority of infrarenal abdominal aortic aneurysm (AAA) repairs in the United States are performed with endovascular methods. Baseline aortoiliac arterial anatomic characteristics are fundamental criteria for appropriate patient selection for endovascular aortic repair (EVAR) and key determinants of long-term success. We evaluated compliance with anatomic guidelines for EVAR and the relationship between baseline aortoiliac arterial anatomy and post-EVAR AAA sac enlargement. Methods and Results- Patients with pre-EVAR and at least 1 post-EVAR computed tomography scan were identified from the M2S, Inc. imaging database (1999 to 2008). Preoperative baseline aortoiliac anatomic characteristics were reviewed for each patient. Data relating to the specific AAA endovascular device implanted were not available. Therefore, morphological measurements were compared with the most liberal and the most conservative published anatomic guidelines as stated in each manufacturer's instructions for use. The primary study outcome was post-EVAR AAA sac enlargement (>5-mm diameter increase). In 10 228 patients undergoing EVAR, 59% had a maximum AAA diameter below the 55-mm threshold at which intervention is recommended over surveillance. Only 42% of patients had anatomy that met the most conservative definition of device instructions for use; 69% met the most liberal definition of device instructions for use. The 5-year post-EVAR rate of AAA sac enlargement was 41%. Independent predictors of AAA sac enlargement included endoleak, age >/=80 years, aortic neck diameter >/=28 mm, aortic neck angle >60 degrees , and common iliac artery diameter >20 mm. Conclusion- In this multicenter observational study, compliance with EVAR device guidelines was low and post-EVAR aneurysm sac enlargement was high, raising concern for long-term risk of aneurysm rupture.
    Source
    Circulation. 2011 Apr 10. Link to article on publisher's site
    DOI
    10.1161/CIRCULATIONAHA.110.014902
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49764
    PubMed ID
    21478500
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1161/CIRCULATIONAHA.110.014902
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