Post-EVAR Endoleaks: A Morphovolumetric Approach to Prediction, Surveillance, and Management

Area of Science:

• Vascular Surgery
• Medical Imaging
• Quantitative Analysis

Background:

• Endovascular aneurysm repair (EVAR) is a common treatment for abdominal aortic aneurysms.
• Post-EVAR surveillance traditionally relies on diameter measurements, potentially missing subtle sac changes.
• Preoperative patient and aneurysm characteristics may influence EVAR outcomes.

Purpose of the Study:

• To determine if preoperative morphometric and morphovolumetric parameters predict post-EVAR sac remodeling, endoleak occurrence, and need for secondary interventions.
• To evaluate the utility of volumetric analysis in post-EVAR surveillance.
• To assess the role of specific endoleak subtypes in patient survival.

Main Methods:

• Retrospective analysis of 383 patients undergoing elective EVAR for infrarenal abdominal aortic aneurysms.
• Inclusion of pre- and postoperative computed tomography angiography with at least 1 year of follow-up.
• Analysis of diameter- and volume-based sac dynamics using 3D morphovolumetric measurements; regression and survival analyses for endoleak risk, secondary interventions, and survival.

Main Results:

• Endoleaks occurred in 26.1% of patients, most commonly type II (12.3%).
• Secondary interventions were needed in 14.1% of patients, primarily for type I and III endoleaks.
• Significant predictors of endoleak included dual antiplatelet therapy, aneurysm length > 133 mm, elevated D-dimer, aneurysm diameter > 59 mm, aneurysm volume > 164 cm³, and thrombus volume > 89 cm³.
• A 10% increase in aneurysm volume correlated with a 4 mm increase in diameter (R² = 0.72, p < 0.001).
• Overall survival did not differ significantly between patients with and without endoleaks, but worse survival was noted for type Ia and III endoleaks.

Conclusions:

• Preoperative morphovolumetric parameters are significant predictors of post-EVAR endoleaks and secondary interventions.
• Volumetric analysis may offer an early indicator of aneurysm sac remodeling, complementing diameter-based assessments, especially for type II endoleaks.
• Prospective validation of proposed volumetric thresholds is necessary before routine clinical use; integrated management considering endoleak subtype and morphovolumetric factors is recommended.