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Nonoperative approach to endotension.
Ari Mennander1, Georg Pimenoff, Maarit Heikkinen
1Division of Vascular Surgery, Tampere University Hospital, Finland. ari.mennander@pshp.fi
Journal of Vascular Surgery
|August 17, 2005
Summary
Endotension after endovascular aneurysm repair (EVAR) can lead to aneurysm rupture. A nonoperative approach may be suitable for asymptomatic patients if imaging excludes endoleak, with four patients showing good outcomes.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Management
Background:
- Endotension following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms is a debated complication.
- The causes and optimal treatment strategies for endotension remain controversial.
Purpose of the Study:
- To evaluate the outcomes of a nonoperative management strategy for patients experiencing endotension after EVAR.
- To investigate the incidence and potential sequelae of endotension in patients undergoing EVAR.
Main Methods:
- A cohort of 160 patients undergoing EVAR for infrarenal abdominal aortic aneurysms were monitored.
- Endotension was defined as aneurysm sac enlargement without endoleak, detected via delayed imaging CT scans.
- Aneurysm sac rupture was identified by discontinuity of the calcific rim and perisaccular fluid.
Main Results:
- Five patients (3.1%) developed endotension post-EVAR.
- Three of these patients experienced aneurysm sac rupture.
- Four patients with endotension were managed nonoperatively and remain clinically well under surveillance.
Conclusions:
- Endotension following EVAR can precipitate aneurysm rupture, independent of endoleak types I-III.
- A nonoperative approach is proposed for asymptomatic patients with aneurysm enlargement post-EVAR, provided endoleak is definitively excluded by imaging.