Identifying Patients at High Risk for Post-EVAR Aneurysm Sac Growth.

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aneurysm Management

Background:

• Post-EVAR aneurysm sac growth is a significant predictor of rupture, representing treatment failure.
• Identifying preoperative predictors for sac growth is essential for improving EVAR outcomes.

Purpose of the Study:

• To identify preoperative patient factors that predict aneurysm sac growth following endovascular aneurysm repair (EVAR).
• To evaluate the association between specific anatomical and clinical factors and post-EVAR sac enlargement.

Main Methods:

• Systematic review of potential preoperative predictors followed by a retrospective analysis of 247 patients undergoing EVAR (2009-2019).
• Inclusion of pre-EVAR CT scans and at least one year of follow-up.
• Multivariate Cox regression and Kaplan-Meier analysis to determine significant predictors of sac growth (≥5 mm diameter increase).

Main Results:

• Infrarenal neck angulation and a higher number of patent lumbar arteries were significantly associated with post-EVAR sac growth.
• Patients with ≥4 patent lumbar arteries showed a higher incidence of sac growth (31%) compared to those with <4 (p<0.001).
• Sac growth occurred in 23% of patients, with endoleak observed in 81% of these cases. AAA rupture occurred in 2.4%.

Conclusions:

• The presence of four or more patent lumbar arteries is a key preoperative predictor of post-EVAR aneurysm sac growth.
• This finding should be incorporated into preoperative counseling for EVAR patients, alongside standard instructions for use.