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Midterm changes in aortic aneurysm morphology after endovascular repair
T Resch1, K Ivancev, J Brunkwall
1Department of Radiology, Malmö University Hospital, Lund University, Malmö, Sweden. tim.resch@rontgen.mas.lu.se
Summary
Midterm follow-up of endovascular aneurysm repair shows infrarenal aortic neck dilation in some patients. Aneurysm shrinkage may plateau after 18 months, with enlargement potentially indicating late failure, especially if endoleaks are present.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Endovascular Interventions
Background:
- Endovascular aneurysm repair (EVAR) is a common treatment for abdominal aortic aneurysms (AAAs).
- Monitoring aneurysm morphology post-EVAR is crucial for assessing long-term outcomes.
- Changes in aortic neck and aneurysm diameter can indicate treatment success or failure.
Purpose of the Study:
- To investigate midterm changes in abdominal aortic aneurysm (AAA) morphology following endovascular repair.
- To assess the evolution of aortic neck diameter and maximum AAA diameter after endograft placement.
- To identify potential indicators of late EVAR failure.
Main Methods:
- Retrospective analysis of 84 patients with AAAs treated with endografts.
- Preoperative and serial follow-up spiral computed tomography (CT) scans.
- Measurements included aortic neck diameter, maximum AAA diameter, and renal artery to bifurcation distance.
Main Results:
- A median increase of 2 mm in aortic neck diameter was observed at 18 months, with significant dilation (>3 mm) in 46% of patients.
- Maximum AAA diameter decreased by a median of 9 mm at 24 months, with no further reduction after 18 months.
- Persistent endoleaks were associated with increasing or unchanged AAA diameters; no change in renal artery to bifurcation distance was noted.
Conclusions:
- The infrarenal aortic neck may dilate post-EVAR in a subset of patients.
- Aneurysm shrinkage appears to stabilize after 18 months, suggesting aneurysm enlargement could signal late failure.
- Graft-related endoleaks are frequently linked to increased aneurysm diameter, highlighting their clinical significance.