Improved Endovascular Aortic Repair Durability in Patients Achieving Increased Shortest Apposition Length: A...

Area of Science:

• Vascular Surgery
• Medical Imaging
• Endovascular Interventions

Background:

• Endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAA) can lead to complications like endoleaks, necessitating re-interventions.
• Proximal seal length is a critical factor in EVAR success, but its prognostic value for long-term outcomes requires further investigation.

Purpose of the Study:

• To evaluate the prognostic significance of proximal seal length changes on post-EVAR computed tomography angiography (CTA) for predicting type 1a endoleak.
• To propose a risk-stratified imaging follow-up algorithm based on proximal seal length dynamics.

Main Methods:

• A multicenter, retrospective observational study included 310 patients undergoing elective EVAR for infrarenal AAA.
• Shortest apposition length (SAL) was measured on initial and follow-up CTAs, with changes categorized as increasing, stable, or decreasing.
• Correlation with type 1a endoleak and re-intervention rates was analyzed using Kaplan-Meier survival analysis.

Main Results:

• An increasing SAL over time was associated with 100% freedom from type 1a endoleak and re-intervention at 5 years.
• A decreasing SAL was linked to a significantly higher incidence of type 1a endoleak (19%) and re-intervention (39.3%) compared to stable or increasing SAL.
• No type 1a endoleak occurred in the increasing SAL group.

Conclusions:

• Increasing shortest apposition length (SAL) after EVAR for infrarenal AAA indicates durable success and absence of type 1a endoleak within 5 years.
• Decreasing SAL is a strong predictor of type 1a endoleak development and subsequent re-interventions.
• Monitoring proximal seal length changes on post-EVAR CTA can refine follow-up strategies and patient risk stratification.