"Large Diameter" Aortic Endografts are Associated With Aneurysm Sac Expansion

Area of Science:

• Vascular Surgery
• Medical Device Technology
• Aortic Aneurysm Management

Background:

• Endovascular aneurysm repair (EVAR) is a common treatment for abdominal aortic aneurysms.
• Device diameter is a critical factor in EVAR success and long-term outcomes.
• Understanding the impact of large-diameter endografts is essential for patient care.

Purpose of the Study:

• To evaluate the association between aortic endograft diameter and long-term outcomes after EVAR.
• To compare outcomes based on endograft size, specifically >34 mm versus smaller devices.
• To identify factors influencing sac expansion in EVAR patients.

Main Methods:

• Retrospective review of 1,099 patients undergoing on-IFU EVAR (2000-2018).
• Comparative analysis of long-term outcomes stratified by endograft diameter (>34 mm vs. smaller).
• Statistical analyses included Kaplan-Meier and Cox proportional hazards models.

Main Results:

• 7.6% of patients received >34-mm endografts; these patients had larger preoperative aneurysm sizes.
• Grafts >34 mm were associated with reduced freedom from sac expansion (P=0.038).
• Patient age, aneurysm size, reintervention, and >34-mm endografts were independent predictors of expansion.

Conclusions:

• Large diameter aortic endografts (>34 mm) are associated with increased rates of sac expansion.
• While large grafts have a role in select cases, they often lack the same regulatory scrutiny as smaller devices.
• Enhanced surveillance is recommended for patients treated with >34-mm endografts, irrespective of IFU compliance.