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Aneurysm Sac Volume Measurements in Patients with and without Type 2 Endoleak Following Endovascular Abdominal Aortic Aneurysm Repair
Young Erben, MD, Manju Kalra, MBBS, Thomas C. Bower, MD, Gustavo Oderich, MD, Audra Duncan, MD, Mark Fleming, MD, Randall De Martino, MD, Peter Gloviczki, MD.
Mayo Clinic, Rochester, MN, USA.
OBJECTIVES: To assess the value of using aneurysm sac volume measurements during follow-up after endovascular aortic aneurysm repair (EVAR)
METHODS: Clinical data from 198 consecutive patients who underwent EVAR from January 2005 to December 2009 and had at least six month imaging follow-up were retrospectively reviewed. Pre- and post-operative maximal anteroposterior diameter (APD) as measured on axial computed tomography angiography (CTA) and aneurysm sac volume (ASV) as measured on centerline of flow CTA analysis were compared. APD and ASV measurements were correlated with absence or presence of endoleak and need for re-intervention
RESULTS: There were 176 male and 22 female patients (mean age: 76±7 years). Endografts employed included Gore Excluder (112), Cook Zenith (61), Medtronic AneuRx (20) and Endologix (5). Mean follow-up was 27±14months (range: 6-66 months). In the entire cohort both mean APD and ASV measured at last follow-up following EVAR had decreased significantly; APD from 58±9mm to 54±1mm (p<0.001) and ASV from 173±80cm3 to 149±77cm3 (p<0.001). Mean APD and ASV change were not significantly different among the 4 types of endografts; Excluder (4mm, 24 cm3), Zenith (6mm, 30 cm3), AneuRx (5mm, 11 cm3) and Endologix (0.4mm, 10 cm3). Among 121 patients without type 2 endoleak (T2E) there was good correlation in mean APD change (58 to 51 mm), (p<0.001) and ASV change (182 to 141cm3), (p<0.001). In 77 patients with T2E overall APD (57 to 57mm) (p=0.98) and ASV (160 to 161cm3) (p=0.80) remained stable. However, in this group, the APD and ASV increased in 42 patients by 6±5mm and 32±37 cm3 respectively; and the APD and ASV decreased in 35 patients by 7±6mm and 31±42 cm3 respectively. In 31 patients undergoing intervention for persistent T2E, the mean APD and ASV change were +3±9mm and +23±65cm3
CONCLUSIONS: There is good correlation between APD and ASV measurements in follow up examination of patients undergoing EVAR. ASV measurements may be more sensitive to smaller magnitude changes in sac size and thus may be more useful in predicting the need for intervention in patients with T2E
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