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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Age and Oversizing Influence Iliac Dilatation after EVAR.

Daphne Elisabeth Gray1, Carla Samaan1, Kyriakos Oikonomou1

  • 1Department of Vascular and Endovascular Surgery, Goethe University Hospital Frankfurt, 60590 Frankfurt, Germany.

Journal of Clinical Medicine
|December 11, 2022
PubMed
Summary
This summary is machine-generated.

Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) shows long-term durability concerns. Iliac limb oversizing correlates with landing zone dilation, while older age may reduce this effect, impacting EVAR success.

Keywords:
EVARabdominal aortic aneurysm repairiliac dilatation

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Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Medical Imaging Analysis

Background:

  • Endovascular aortic repair (EVAR) is a primary treatment for infrarenal abdominal aortic aneurysms (AAA).
  • Long-term durability of EVAR remains a concern, potentially linked to changes in aortoiliac anatomy at the landing zones.
  • Understanding morphological changes in the iliac landing zone is crucial for improving EVAR outcomes.

Purpose of the Study:

  • To investigate morphological changes in the distal iliac landing zone following EVAR.
  • To identify risk factors associated with iliac sealing failure after EVAR.
  • To assess the impact of stent graft oversizing and patient age on iliac artery anatomy over time.

Main Methods:

  • Retrospective analysis of a single-center registry of patients treated with EVAR between 2008 and 2018.
  • Inclusion criteria: minimum one-year clinical follow-up; minimum one-year CT follow-up with at least two scans for morphological analysis.
  • Evaluation of clinical data and CT imaging for iliac anatomy changes, endoleaks, and iliac limb detachment.

Main Results:

  • Iliac limb detachment occurred in 18.2% of target vessels; type 1b endoleak in 3%.
  • Significant iliac artery diameter increase at the landing zone was observed, independent of endoleak.
  • Higher iliac limb oversizing correlated with greater landing zone diameter increase over time (p < 0.001).
  • Older patients exhibited a lower diameter increase in the distal landing zone compared to younger patients (p < 0.001).

Conclusions:

  • Iliac limb oversizing is associated with increased distal landing zone dilatation post-EVAR.
  • Older patient age appears to be inversely related to iliac diameter increase.
  • Further research is needed to elucidate the interplay between stent graft oversizing, age, and iliac anatomy changes to enhance EVAR durability.