Aneurysm Sac Size Research Articles

Operative and Midterm Outcomes of the Fenestrated Anaconda Stent-Graft in the Endovascular Treatment of Juxtarenal, Suprarenal, and Type IV Thoracoabdominal Aortic Aneurysms

Purpose: To report operative and midterm outcomes of fenestrated endovascular aneurysm repair (FEVAR) with the Anaconda device. Methods: A retrospective analysis was conducted of 39 consecutive patients (median age 74 years; 36 men) treated with the fenestrated Anaconda stent-graft between July 2011 and December 2015 at a single center. Indications for FEVAR were abdominal aortic aneurysms (AAAs) with neck anatomy unsuitable for a standard stent-graft. Median infrarenal neck length was 4 mm (range 0–9). Four (10%) patients presented with type IV thoracoabdominal aortic aneurysm (TAAA), 12 (31%) with suprarenal aneurysms, and 23 (59%) with juxtarenal aneurysms. Four (10%) patients had previous infrarenal aortic repair. Five (13%) patients had an infrarenal neck angulation >60°. A total of 106 fenestrations were incorporated into the stent-grafts (73 renal arteries, 25 superior mesenteric arteries, and 8 celiac trunks). Technical success, perioperative and midterm mortality and morbidity, target vessel patency, endoleaks, and reinterventions were documented. Results: Technical success was 95% (37/39). Three (8%) patients died in-hospital from mesenteric embolism in 2 and renal artery rupture with consequent multiorgan failure in 1. Two (5%) patients suffered an intraoperative embolic stroke. During a median follow-up of 33 months (range 4–55), adjunctive maneuvers were performed in 9 (23%) patients, including reintervention for type II endoleak with enlarged aneurysm sac in 2 (5%). Four additional patients died of causes unrelated to the aortic pathology (overall mortality 18%). In 34 (94%) of the 36 patients seen in follow-up, aneurysm sac size was stable or decreased. Target vessel stent patency was 99% (95/96). Conclusion: FEVAR with the Anaconda device delivers satisfactory short-term technical and clinical success rates in patients with juxtarenal, suprarenal, and type IV TAAA. Midterm efficacy and durability with respect to aneurysm sac regression and target vessel patency appear very good. Overall mortality and the need for reintervention were significant in this patient cohort.

Transcaval Access Provides a Safe and Effective Method in the Treatment of Type II Endoleaks

We aimed to describe our technique and preliminary results of transcaval access for treatment of type II endoleaks after endovascular aneurysm repair. We performed a retrospective review of a prospective data registry collected from January 1, 2015, to March 1, 2016. Our standardized technique is described as follows. Under fluoroscopic guidance, a 19-gauge transjugular liver biopsy needle is passed by transfemoral venous access through the inferior vena cava into the aneurysm sac at the site of maximal aortocaval apposition. Confirmation of sac entrance is confirmed by anterior/posterior and lateral fluoroscopic and angiographic imaging. Over a stiff wire, a sheath and catheter are then introduced into the aneurysm sac. Transarterial, intra-aortic angiography facilitates localization of the endoleaks. The intrasac catheter and wire are used to catheterize the ostium of the vessel responsible for type II endoleak. Coil embolization of the catheterized vessel or of the vessel ostium is performed. Technical success was defined as resolution of the endoleak on repeated intra-arterial angiography. Additional outcome measures included resolution of the type II endoleak and aneurysm sac expansion on follow-up imaging. Computed tomography angiography was performed for all patients except those with stage 3 or higher chronic kidney disease. Abdominal aortic duplex ultrasound was used to determine the presence of endoleak in these patients. Four patients underwent transcaval embolization for an expanding aneurysm sac; 75% of the patients were male. The average age was 78.7 years. Average preintervention aneurysm sac size was 8.5 cm (6.7-10.6 cm). In two patients, previous transarterial/translumbar embolization attempts had failed. The technical success rate for transcaval embolization was 100%. The average fluoroscopy time was 34.6 minutes. The average amount of contrast material administered was 60 mL. The number of coils deployed averaged 8.75 (3-11). There were no immediate postoperative complications. Follow-up ranged from 1 to 12 months. All patients remained free of endoleaks with stable or decreasing aneurysm sac size. No patients developed any complications associated with the inferior vena cava or femoral veins. Transcaval access is a safe and effective alternative method for treating type II endoleaks. In addition, it can be considered a primary or secondary approach after failed intra-arterial or translumbar attempts.

Outcomes of type II endoleaks after endovascular abdominal aortic aneurysm (AAA) repair: a single-center, retrospective study

PurposeThis study aims to determine incidence and outcomes of type II endoleaks (T2E) after endovascular abdominal aortic aneurysm repair (EVAR). MethodsA retrospective review of procedural angiograms, computed tomography angiography, and medical records of 202 patients who underwent EVAR with the Gore Excluder stent graft was performed to determine presence and outcomes of T2E. ResultsMedian follow-up time for 163 patients meeting inclusion criteria [136 males (83%)] was 24.7 months (range=0.5–85.2 months). T2E occurred in 66/163 patients (40.5%). Aneurysm sac size was unchanged in 32/66 patients (48.5%), decreased in 22/66 (33.3%), and increased in 12/66 (18.2%). No aneurysm ruptures, conversion to open repair, or aneurysm-related deaths occurred. ConclusionT2E are a common occurrence after EVAR, often with benign outcome. However, routine surveillance should be performed, particularly in patients with persistent endoleak or sac growth.

Abstract No. 462 - Off-label intravascular uses of embolic glue: how we avoid sticky situations

No. 461 Does billowing of the Endologix Powerlink Stent Graft correlate with decrease in aneurysm sac size? N. Helo, W. Wang, A. Chang, C. Hyun, K. Chon, A. Yi; Loma Linda University Medical Center, Loma Linda, CA; Jacksonville, FL; VA Loma Linda Healthcare System, Loma Linda, CA; Loma Linda Veterans Hospital, Loma Linda, CA; Anaheim, CA Purpose: Billowing is unique to the Endologix stent graft where a crescentic rim of contrast is seen outside the metallic endoskeleton but is still contained within the outer plastic graft as the graft is not attached to the metallic endoskeleton at all points. Contrast within the potential space visualized on imaging is termed billowing. Previous studies have shown high incidence of billowing in patients but have not shown correlation between billowing and change in aneurysm sac size. The objective is to determine if billowing with patients with the Endologix Powerlink Stent Graft correlates with a decrease in aneurysm sac size. Materials: After our IRB approval, a chart review of imaging and progress notes of 122 consecutive patients with placement of the Endologix stent graft from 2009-2012 was performed. We have an extensive imaging follow-up program of patients that have EVAR performed. Two attending radiologists and a radiology resident individually reviewed the imaging and recorded data. The data was then analyzed with statistics to prove correlations. Results: 100 patients had follow-up imaging in which 84 patients had billowing. An independent T-test showed that there is a statistical difference in the absolute change in size of the aneurysm sac size in AP and transverse dimensions as well as the percent change of the aneurysm sac size in transverse dimension in billowing versus non-billowing groups (P1⁄4 0.014, 0.009, 0.006 respectively). The independent T-Test showed no statistical difference in the percent change of aneurysm sac size in AP dimension in billowing versus non-billowing groups (P1⁄40.059). Conclusions: Billowing helps reduce aneurysm sac size in absolute change in size of the aneurysm sac size in AP and transverse dimensions as well as the percent change of aneurysm sac size in transverse dimension.

Type 2 Endoleaks: The Diagnostic Performance of Non-Specialized Readers on Arterial and Venous Phase Multi-Slice CT Angiography.

PurposeTo define the diagnostic precision of non-specialized readers in the detection of type 2 endoleaks (T2EL) in arterial versus venous phase acquisitions, and to evaluate an approach for radiation dose reduction.MethodsThe pre-discharge and final follow-up multi-slice CT angiographies of 167 patients were retrospectively analyzed. Image data were separated into an arterial and a venous phase reading set. Two radiology residents assessed the reading sets for the presence of a T2EL, feeding vessels, and aneurysm sac size. Findings were compared with a standard of reference established by two experts in interventional radiology. The effective dose was calculated.ResultsOverall, experts detected 131 T2ELs, and 331 feeding vessels in 334 examinations. Persistent T2ELs causing aneurysm sac growth > 5 mm were detected in 20 patients. Radiation in arterial and venous phases contributed to a mean of 58.6% and 39.0% of the total effective dose. Findings of reader 1 and 2 showed comparable sensitivities in arterial sets of 80.9 versus 85.5 (p = 0.09), and in venous sets of 73.3 versus 79.4 (p = 0.15), respectively. Reader 1 and 2 achieved a significant higher detection rate of feeding vessels with arterial compared to venous set (p = 0.04, p < 0.01). Both readers correctly identified T2ELs with growing aneurysm sac in all cases, independent of the acquisition phase.ConclusionArterial acquisitions enable non-specialized readers an accurate detection of T2ELs, and a significant better identification of feeding vessels. Based on our results, it seems reasonable to eliminate venous phase acquisitions.

Abstract No. 461 - Does billowing of the Endologix Powerlink Stent Graft correlate with decrease in aneurysm sac size?

Abstract No. 461 - Does billowing of the Endologix Powerlink Stent Graft correlate with decrease in aneurysm sac size?

Abstract TP94: Effect of Flow Diversion on Large and Giant Aneurysms: an MRI-DSA Correlation Follow-up Study

Background: There is sparse literature on the effect of flow diversion (FD) on large or giant intracranial aneurysms. We assessed the effects of FD with Pipeline stent on aneurysm sac size using MRI follow-up Methods: All patients at our institution who underwent FD for treatment of intracranial aneurysms were retrospectively identified. Aneurysms with maximum dimension &gt; 20mm, with pre and post treatment MRI were selected. These aneurysms were not previously treated, and did not receive adjunctive devices for current treatment. The largest diameter in 2-dimensions was measured on the MRI sequence that best demonstrated the aneurysm sac, and compared on serial scans. MRI changes were compared to DSA where aneurysm occlusion was graded by the O'Kelly-Marotta (OKM) scale. Results: Between 6/2011-4/2015, 87 patients with 96 aneurysms were treated with FD. Eighteen patients had aneurysm &gt;20mm. Pre and post treatment MRI were available in 12/18 (67%) patients. This included 9 (75%) females, with mean age 65.5 years. All aneurysms were unruptured and symptomatic. Nine (75%) patients had cavernous/ophthalmic aneurysms, and 3 had basilar aneurysms. Average largest aneurysm diameter was 26.7 (range 21-37) mm. Pipeline was used in all patients (mean 1.9, range 1-5 stents), with 8 (67%) requiring &gt; 1 stent. At the first MRI follow-up (median 4, range 1-18 months), 4 (33%) aneurysms decreased in size, 6 (50%) remained stable, 1 (8%) increased in size. The stent thrombosed in the last patient. At the last MRI follow-up (median 10.5, range 1-48 months), 9 (75%) aneurysms decreased in size and 2 (16%) remained stable from baseline. No aneurysm completely resolved. DSA follow-up was available in 10 (83%) patients (median 9, range 1-25 months). Patients with decreased size on MRI had OKM grade C2, C3 or D, while aneurysms with stable size had OKM grade B3. The one patient with initial increased size on MR had corresponding OKM grade D (no filling). Conclusion: Majority (75%) of large aneurysms decrease in size on serial MRIs after FD treatment. This corresponds with no filling or early remnant on DSA. Rare aneurysms increase in size despite no filling on DSA, which suggests caution when using only DSA follow-up post treatment. These findings require further study.

Post-Test Questions

Which of the following imaging modalities CANNOT provide an accurate assessment of aneurysm sac size enlargement on routine surveillance?

Aortic stent-grafts: Endoleak surveillance.

Endoleaks have been referred to as the "Achilles heel" of endovascular aortic aneurysm repair (EVAR) and are the most common complication of this procedure. An endoleak can maintain a high systemic blood pressure within the aneurysm sac, potentially leading to rupture. Follow-up is therefore mandatory to detect and classify possible endoleaks. Computed tomography (CT) remains the gold standard for follow-up, but provides no hemodynamic information on endoleaks and has the disadvantages of exposing patients to iodine contrast and X-ray radiation. Exposure to radiation could be reduced in various ways, by simplifying the triphasic protocol using dual-energy CT imaging, limiting the amount of radiation per slice using iterative reconstruction, and reducing the follow-up schedule that could be altered to include non-ionizing radiation imaging techniques. Contrast-enhanced ultrasound (CEUS) is an interesting alternative to CT, as is magnetic resonance (MR) imaging that can be used as an alternative or for complementary imaging. Long-term follow-up schedules are currently based on repeated CT. However, more recently alternative follow-up protocols have been proposed for patients with no endoleaks nor increase in aneurysmal sac size. These new protocols consist of CT imaging at 1month and 1year after treatment, subsequently followed by CEUS. Nevertheless, the mechanical structure of the stent-graft must still be verified by CT. The use of patient-specific risk-adjusted follow-up protocols, based on preoperative imaging and the first postoperative results, is gradually becoming more and more widespread.

Results of the Treatment by Embolization of the Type II Endoleaks Associated with an Increase in Aneurysmal sac Size

Results of the Treatment by Embolization of the Type II Endoleaks Associated with an Increase in Aneurysmal sac Size

Transcatheter Embolisation of Proximal Type 1 Endoleaks Following Endovascular Aneurysm Sealing (EVAS) Using the Nellix Device: Technique and Outcomes.

To evaluate the technical success and mid-term outcomes following transcatheter embolisation of type 1a endoleak after Nellix endovascular aneurysm sealing (EVAS). Seven patients (5 men; mean age 83; range 79-90) underwent transcatheter embolisation between July 2013 and August 2014. The average time from EVAS to embolisation was 136 days (range 6-301) and from endoleak diagnosis to embolisation was 20 days (range 2-50). Embolisation was performed with coils and Onyx in six cases and Onyx only in one case. Technical success, imaging and clinical outcomes of embolisation were reviewed. Technical success was defined as elimination of the endoleak on completion angiography and first imaging follow-up. Clinical success was defined as unchanged or decreased aneurysm sac size on subsequent follow-up (average 8 months; range 103-471 days). All cases were technically successful. One patient required a second endovascular procedure following Onyx reflux into the Nellix endograft and another patient required surgical closure of a brachial puncture site. All patients are endoleak free with stable sac size on the latest available follow-up imaging. If a type 1 endoleak occurs after EVAS, embolisation using Onyx with or without coils is feasible and effective with high technical success and freedom from endoleak recurrence at mid-term follow-up.

Type II endoleak with or without intervention after endovascular aortic aneurysm repair does not change aneurysm-related outcomes despite sac growth

There is considerable controversy about the significance and appropriate treatment of type II endoleaks (T2Ls) after endovascular aneurysm repair (EVAR). We report our long-term experience with T2L management in a large multicenter registry. Between 2000 and 2010, 1736 patients underwent EVAR, and we recorded the incidence of T2L. Primary outcomes were mortality and aneurysm-related mortality (ARM). Secondary outcomes were change in aneurysm sac size, major adverse events, and reintervention. During the follow-up (median of 32.2 months; interquartile range, 14.2-52.8 months), T2L was identified in 474 patients (27.3%). There were no late abdominal aortic aneurysm ruptures attributable to a T2L. Overall mortality (P = .47) and ARM (P = .26) did not differ between patients with and without T2L. Sac growth (median, 5 mm; interquartile range, 2-10 mm) was seen in 213 (44.9%) of the patients with T2L. Of these patients with a T2L and sac growth, 36 (16.9%) had an additional type of endoleak. Of all patients with T2L, 111 (23.4%) received reinterventions, including 39 patients who underwent multiple procedures; 74% of the reinterventions were performed in patients with sac growth. Reinterventions included lumbar embolization in 66 patients (59.5%), placement of additional stents in 48 (43.2%), open surgical revision in 14 (12.6%), and direct sac injection in 22 (19.8%). The reintervention was successful in 35 patients (31.5%). After patients with other types of endoleak were excluded, no difference in overall all-cause mortality (P = .57) or ARM (P = .09) was observed between patients with T2L-associated sac growth who underwent reintervention and those in whom T2L was left untreated. In our multicenter EVAR registry, overall all-cause mortality and ARM were unaffected by the presence of a T2L. Moreover, patients who were simply observed for T2L-associated sac growth had aneurysm-related outcomes similar to those in patients who underwent reintervention. Our future work will investigate the most cost-effective ways to select patients for intervention besides sac growth alone.

Adherence to endovascular aortic aneurysm repair device instructions for use guidelines has no impact on outcomes

Prior reports have suggested unfavorable outcomes after endovascular aortic aneurysm repair (EVAR) performed outside of the recommended instructions for use (IFU) guidelines. We report our long-term EVAR experience in a large multicenter registry with regard to adherence to IFU guidelines. Between 2000 and 2010, 489 of 1736 patients who underwent EVAR had preoperative anatomic measurements obtained from the M2S, Inc, imaging database (West Lebanon, NH). We examined outcomes in these patients with regard to whether they had met the device-specific IFU criteria. Primary outcomes were all-cause mortality and aneurysm-related mortality. Secondary outcomes were endoleak status, adverse events, reintervention, and aneurysm sac size change. The median follow-up for the 489 patients was 3.1 years (interquartile range, 1.6-5.0 years); 58.1% (n = 284) had EVAR performed within IFU guidelines (IFU-adherent group), and 41.9% (n = 205) had EVAR performed outside of IFU guidelines (IFU-nonadherent group). Preoperative anatomic data showed that 62.4% of the IFU-nonadherent group had short neck length, 10.2% had greater angulation than recommended, 7.3% did not meet neck diameter criteria, and 20% had multiple anatomic issues. A small portion (n = 49; 10%) of the 489 patients were lost to follow-up because of leaving membership enrollment (n = 28), moving outside the region (n = 10), or discontinuing image surveillance (n = 11). There was no significant difference in any of the primary or secondary outcomes between the IFU-adherent and IFU-nonadherent groups. Aneurysm sac size change at any time point during follow-up also did not differ significantly between the two groups. A Cox proportional hazard model showed that IFU nonadherence was not predictive of all-cause mortality (hazard ratio, 1.0; P = .91). Similarly, IFU nonadherence was not identified as a risk factor for aneurysm-related mortality or adverse events in stepwise Cox proportional hazards models. In our cohort of EVAR patients with detailed preoperative anatomic information and long-term follow-up, overall mortality and aneurysm-related mortality were unaffected by IFU adherence. In addition, rates of endoleak and reintervention after initial EVAR were similar, suggesting that lack of IFU-based anatomic suitability was not a driver of outcomes.

Effect of flow diversion with silk on aneurysm size: A single center experience.

Alterations in aneurysm size and mass effect can result in alleviation or aggravation of symptoms. We assessed the effects of flow diversion with SILK stents on aneurysm sac size and associated factors. A retrospective evaluation of 14 aneurysms treated with SILK stents alone with MRI follow-up was performed. Aneurysm sac size was measured using the sequence best demonstrating the sac. Aneurysm characteristics and flow-related enhancement on time of flight images were documented. Clinical histories were reviewed for evolution of symptoms. Complete collapse of the aneurysm sac was demonstrated at three and 18 months in 2/14 aneurysms. Increase in size was observed in 2/14 aneurysms with associated persistent flow on time of flight MRA. Blister formation with aggravation of symptoms was observed in one aneurysm, and subsequent decrease in size occurred after treatment with a second SILK. The other aneurysm which increased in size initially continued to enlarge asymptomatically despite retreatment with a second SILK, however at 24 months thrombosis of the sac and decrease in size was observed. The remaining 10/14 aneurysms decreased in size. Nine had corresponding MRA occlusion and the tenth demonstrated decreased but persistent flow on the time of flight MRA. No aneurysm with MRA occlusion increased in size. Decrease in sac size was associated with MRA occlusion in our study. Persistence of flow and blistering were associated with increased sac size. As previously demonstrated flow diversion may be effective in the treatment of large aneurysms presenting with mass effect, however rates of sac obliteration in this small series were not as high as previously reported.

Duplex Ultrasonography and its Use in Surveillance Post-EVAR

After endovascular aortic aneurysm repair (EVAR), patients require annual surveillance with either CT scan or duplex ultrasonography (DU). These studies should be used to identify patients who require reintervention for EVAR complications. DU, a less expensive and radiation free option, has been shown to accurately predict aneurysm sac size and endoleak. In addition, using criteria of PSV<300 cm/s and PSV ratio <3.5, DU can rule out limb stenosis. After a normal post-procedure DU, only 2.2% of patients require reintervention within the first 3 years suggesting that less frequent follow-up may be utilized. DU is an important tool in the surveillance of EVAR patients.

Factors affecting anatomical changes after endovascular abdominal aortic aneurysm repair.

The primary goal of endovascular aneurysm repair (EVAR) is to prevent death from aneurysm rupture. Regression of aortic sac size is believed to be a marker for success after EVAR. This study analyzes the changes in aneurysm sac size and the factors affecting sac regression after EVAR. We retrospectively reviewed 121 patients with abdominal aortic aneurysm (AAA) who underwent elective treatment with EVAR at our institution from January 2005 to December 2011. In this study, 17 of the 121 patients were excluded due to loss during follow-up or for not having undergone a postoperative computed tomographic (CT) scan, and 3 patients were excluded due to an isolated iliac artery aneurysm. CT scans were scheduled at months 1, 6, and 12, and annually thereafter. Aneurysm size was defined by the minor axis on the largest axial cut of the aneurysm on a two-dimensional CT scan. Sac regression was defined as a reduction in the diameter of more than 5 mm. Sac regression was observed during follow-up in 39 of the 101 patients. There was 1 regression in 87 patients (1%) at 1 month, 18 in 62 patients at 6 months (29%), 26 regressions in 44 patients (59%) at 12 months, and 18 regressions in 34 patients (53%) at 24 months. After multivariate analysis, the absence of endoleaks was the only factor associated with sac regression (hazard ratio, 3.620; confidence interval, 1.692-7.747; p = 0.001). Sac regression over 5 mm is associated with current or previous endoleaks after EVAR. Continued surveillance is necessary in all patients after EVAR to prevent late complications.

E-035 Symptomatic Fusiform Basilar Artery Aneurysm: "Kissing" Stent Reconstruction

IntroductionA case presentation of the treatment of a large-giant, symptomatic, fusiform basilar artery aneurysm using kissing telescopic stents. The patient is a 53 year old male who presented for further...

The radiological appearance of intracranial aneurysms in adults infected with the human immunodeficiency virus (HIV)

Background: The global prevalence of intracranial aneurysms is estimated at 2.3%. Limited literature is available on intracranial aneurysms in HIV-infected patients.Objectives: To describe the radiological appearance of intracranial aneurysms in HIV-positive adults.Method: In this retrospective analysis of data, 23 HIV-positive patients, of which 15 (65.2%)were female, with a total of 41 aneurysms were included. The mean age was 38 years, and their median CD4 count was 305 x 106/L. Inclusion criteria comprised subarachnoid haemorrhage and confirmed intracranial aneurysms on four-vessel angiography.Results: Fifteen (65.2%) patients had a single aneurysm, of which 12 (80.0%) had a saccular appearance. Seven (46.7%) of the single aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.9 mm and the transverse diameter 4.4 mm. More than half of these aneurysms occurred at the anterior communicating artery. The median CD4 count of single-aneurysm patients was 319 x 106 /L. Eight patients (34.8%) had multiple aneurysms, with a total of 26 aneurysms (range 2–6 aneurysms per patient), of which 13 (50.0%) had a complex appearance. Twenty-four (92.3%) of the multiple aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.0 mm and the transverse diameter 3.9 mm. The multiple aneurysms occurred more commonly in the internal carotid artery. These patients had a median CD4 count of 294 x 106/L.Conclusion: HIV-associated intracranial aneurysms occur at a younger age, appear to be saccular and complex in shape, with a wide neck, and might rupture at small sizes.

Unusual Perigraft Abscess Formation Associated with Stent Graft Infection after Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Case Report

The incidence of aortic stent graft infection is with 0.2% to 0.7% low (1). However, there is an increasing need to be vigilant for the risk of stent graft infections as there are more patients treated using the endovascular technique. An early detection of graft infections and an adequate treatment during follow-up are also important to prevent serious complications. There have been several reports on stent graft infection with its characteristic clinical presentations and computed tomography (CT) findings (2-6). However, even with these characteristic CT findings, there have been few cases reported of abscess formation due to graft infection without characteristic CT findings, which could lead to either misdiagnosis or delayed diagnosis. We report a case of perigraft abscess formation that showed an increased size of aneurysmal sac without any apparent evidence of causative risk factors and was developed as a late complication 2 years after endovascular aortic repair (EVAR) for an abdominal aortic aneurysm (AAA).

Statins Promote Residual Aneurysm Sac Regression Following Endovascular Aortic Aneurysm Repair

Regression of the residual sac is indicative of successful endovascular aortic aneurysm (EVAR) repair. Using color duplex ultrasound (CDU), we monitored the residual aneurysm sac following EVAR and correlated sac behavior with perioperative risk factors. Of 145 patients with EVAR, 106 (73.1%) patients between January 01, 2003, and July 01, 2010, had at least 2 consecutive postoperative scans and thus were eligible for inclusion. Mean (± standard deviation [SD]) CDU scans per person was 4.6 (± 1.4). All were conducted by the same technologist using a standard protocol on the same machine. Aneurysm sac change in centimeters and percentage terms was calculated. The presence or absence of an endoleak was also recorded. Change in aneurysm sac size was correlated with preoperative risk factors. Mean sac size change at 1 month was a decrease of 0.24 cm, equating to a percentage change of 4.3%. At 7 months, the decrease was 0.59 cm (9.8%), at 12 months, 0.73 cm (12.4%), at 18 months 0.92 cm (15.8%), and at 36 months 1.0 cm (16.6%). Both univariate and multivariate analyses demonstrated that statin therapy (P = .002) was the only risk factor variable positively associated with aneurysm regression while the presence of an endoleak was inversely related to sac reduction (P = .01). Maximum aneurysmal sac reduction seems to occur in the first year following endograft implantation. Statin therapy appears to be associated with an increased likelihood of sac regression following EVAR. Further investigation of the role of statins in the biology of abdominal aortic aneurysmal disease is warranted.