Change In Aneurysm Diameter Research Articles

Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft

Objective: The objective of this study was to evaluate gender differences in the selection, procedure, and outcome of endovascular abdominal aortic aneurysm repair (EVAR). Patients: Between October 1996 and January 2001, 378 patients were evaluated for EVAR and 189 patients underwent EVAR with the Medtronic AneuRx stent graft at a single center. Results: Women constituted 17% of patients considered for EVAR. Their eligibility rate (49%) did not differ significantly from that of men (57%), and they constituted 14% of patients who underwent EVAR (26/189). Women who underwent EVAR were older (77.9 ± 6.3 years versus 73.1 ± 8.1 years; P <.005) with a higher rate of chronic obstructive lung disease (50% versus 28%; P <.05). Maximal aneurysm diameter (57.2 ± 10.9 mm versus 57.8 ± 9.4 mm; not significant) did not differ between men and women. Mean diameters of the proximal neck (20.4 ± 2.3 mm versus 22.3 ± 2.0 mm; P <.01), common iliac arteries (11.4 ± 1.2 mm versus 13.5 ± 3.6 mm; P <.001), and external iliac arteries (7.9 ± 0.7 mm versus 9.4 ± 1.4 mm; P <.001) were all smaller in women, and abdominal aortic aneurysm/neck diameter ratio was larger (2.82 ± 0.59 versus 2.60 ± 0.49; P <.05). The length of the proximal aortic neck was shorter in women (20.7 ± 8.2 mm versus 24.5 ± 11.8 mm; P <.05). Women had significantly more intraoperative complications (31% versus 13%; P <.05), primarily related to arterial access, and needed more frequent arterial reconstruction (42% versus 21%; P <.05), without a difference in postoperative mortality rate (0/26 versus 2/163; not significant) and complication rate (23% versus 20%: not significant). During a follow-up period of 13.8 ± 11.7 months, no gender-related difference was found in survival rate, endoleak rate, or reintervention rate or in the rate of change in aneurysm diameter or volume. Conclusion: Eligibility rates of women for EVAR are similar to those of men. Women are at an increased risk for access-related complications during EVAR, but outcome is equivalent to that of men. (J Vasc Surg 2002;35:882-6.)

Endoleak: Predictive Value for Aneurysm Growth at 3 Years

Endoleak is a unique radiographic finding after endovascular aneurysm repair. The prognostic implication of endoleak on aneurysm therapy outcome is unknown. Patients with 3 years of follow-up were examined to determine the predictive value of endoleak, as determined by the treating physician, for aneurysm growth. Patients enrolled in a clinical trial for a unibody, bifurcated endovascular graft (Ancure-Guidant/EVT, Menlo Park, CA) were examined with respect to endoleak, as determined by the primary investigator, and aneurysm diameter change. A total of 80 patients were available at 3 years for evaluation. CT scans and ultrasound were used to determine endoleak at discharge, at 6 months, and annually. Patients were categorized as no leak (NL; n = 59), early leak (EL, leak identified by 6 months; n = 15), and late leak (LL, leak identified at 12 months or later; n = 6). A change of 5 mm in transverse diameter relative to the original diameter was used to determine an increase or decrease. Therapeutic intervention for endoleak was analyzed separately in each group. From the results we were able to determine that most patients with distal type 1 or type 2 endoleak have shrinking or stable aneurysms. Endoleak is a poor predictor of aneurysm growth but is statistically associated with enlargement. Absence of endoleak is strongly, but not entirely, predictive of lack of aneurysm growth. Endoleak is a risk factor for aneurysm enlargement, warranting further investigation to examine the etiology of the image, but cannot be used as an endpoint for effective endovascular aneurysm treatment.

Diameter changes in isolated iliac artery aneurysms 1 to 6 years after endovascular graft repair

Objective: Precise diameter changes in iliac artery aneurysms (IAAs) after endovascular graft (EVG) repair are yet to be determined. This report describes the midterm size changes in isolated IAAs 13 to 72 months after treatment with an EVG. Methods: From January 1993 to April 1999, 31 patients with 35 true isolated IAAs (32 common iliac and 3 hypogastric) had these lesions treated with EVGs and coil embolization of the hypogastric artery or its branches. The EVG used in this study consisted of a balloon-expandable stent attached to a polytetrafluoroethylene graft. Contrast-enhanced spiral computed tomographic scans were performed at 3- to 6-month intervals to follow the aneurysms for change in diameter and endoleaks. Results: Thirty patients had a decrease in the size of their iliac aneurysms with EVG repair. All EVGs remained patent. All patients, except for one, were followed up for 13 to 72 months (mean, 31 months). The pretreatment aneurysm size ranged from 2.5 to 11.0 cm in diameter (mean, 4.6 ± 1.62 cm). After EVG treatment, the aneurysms ranged from 2.0 to 8.0 cm in diameter (mean, 3.8 ± 1.36 cm). The change in aneurysm diameter ranged from 0.5 to 3.1 cm (mean, 1.1 ± 0.62 cm) with an average change of –0.516 ± 0.01 cm/y for the first year. Five patients died of their intercurrent medical conditions during the follow-up period. One of the patients had a new endoleak and an increase in common iliac aneurysm size 18 months after EVG treatment, despite an early contrast-enhanced computed tomographic scan that showed no endoleak. This patient's aneurysm ruptured, and a standard open surgical repair was successfully performed. Another patient had a decrease in hypogastric aneurysm size after EVG treatment and no radiographic evidence of an endoleak, but eventually the aneurysm ruptured. He was successfully treated with a standard open surgical repair. Conclusions: EVGs can be an effective treatment for isolated IAAs. Properly treated with EVGs, IAAs decrease in size. The enlargement of an IAA, even if no endoleak can be detected, appears to be an ominous sign suggestive of an impending rupture. IAAs that enlarge should be closely evaluated for an endoleak. If an endoleak is detected, it should be eliminated if possible. If an endoleak cannot be found, open surgical repair should be considered. (J Vasc Surg 2001;33:289-95.)

Persistent collateral perfusion of abdominal aortic aneurysm after endovascular repair does not lead to progressive change in aneurysm diameter

Purpose: To differentiate between the phenomenon of collateral perfusion from a side branch versus graft-related endoleaks after endovascular repair of abdominal aortic aneurysms (AAA), with respect to aneurysm size and prognosis. Methods: We successfully treated 64 AAA patients with endovascular grafting. We followed all the patients postoperatively with spiral computed tomography at one, three, six and 12 months, and biannually thereafter. We measured aneurysm diameters preoperatively and postoperatively. We calculated preoperatively the relation of maximum aortic diameter (D) to the thrombus-free lumen diameter (L) expressed as an L/D ratio. Median follow-up was 15 months. Results: Sixteen patients had collateral perfusion during follow-up. We successfully treated two patients with embolization. One patient showed resolution of collateral perfusion after we stopped warfarin treatment. Two patients died of unrelated causes during follow-up. One patient was converted to surgical treatment, and two patients showed spontaneous resolution of their collateral perfusion. The group of patients with perfusion showed no statistically significant change of their aortic diameter on follow-up. The group of patients without perfusion showed a median decrease in aortic diameter of 8mm ( p < 0.0001) at 18 months postoperatively. The group of patients with perfusion had significantly less thrombus in their aneurysm sac preoperatively than the group without perfusion, as expressed by the L/D ratio (mean L/D 0,61 versus 0,78, respectively; p = 0.0021.) Conclusion: There was no significant increase in aortic diameter on an average 18 months postoperatively despite persistent collateral perfusion. This may indicate a halted disease progression in the short term. Embolization of collateral vessels is associated with risk of paraplegia. We recommend a conservative approach with close observation if aneurysm diameter is stable. (J Vasc Surg 1998;28:242-9.)