Predicting Visceral Aortic Growth after Infrarenal AAA Repair
Sean P. Steenberge, MD, MS, Daniel G. Clair, MD, Matthew J. Eagleton, MD, Christopher J. Smolock, MD, Francis J. Caputo, MD, Sean P. Lyden, MD.
Cleveland Clinic, Cleveland, OH, USA.
Objective: To identify predictors of aortic aneurysm growth above an infrarenal abdominal aortic aneurysm (AAA) repair.
Methods: This was a single center, retrospective cohort study that examined 881 infrarenal AAA repairs from 2004-2008 and identified 187 of the repairs with pre-operative and post-operative imaging at least 1 year from repair to evaluate for aortic growth after infrarenal AAA repair. Pre-operative and post-operative CT imaging measured aortic diameters at the celiac, superior mesenteric, and renal arteries. Pre-operative CT imaging also measured aortic thrombus and calcification volumes in the visceral and infrarenal abdominal aortic segments. Multivariable modeling was used with log transformed variables to determine potential predictors of future aortic aneurysm development after infrarenal AAA repair.
Results: Of the 187 patients in the cohort, 100 had an open AAA repair while 87 had an endovascular AAA repair. Visceral aortic wall degeneration defined as greater than 5mm of growth within the visceral aortic segment after infrarenal AAA repair occurred in 27% of the cohort during an average of 72 ± 34.2 months of follow-up within the healthcare system. Twenty-six percent of the cohort developed aortic aneurysms above their infrarenal AAA repair during the same follow-up period. After multivariable modeling, visceral segment aortic thrombus on pre-operative CT imaging was associated with an increased risk of aortic aneurysm development above the infrarenal AAA repair within both the open (HR 2.04, p=0.033) and endovascular(HR 3.31, p=0.004) repair cohorts. Endovascular repair was found to be associated with a higher risk of future aortic aneurysm development after infrarenal AAA repair when compared to open repair (HR 2.19, p=0.025) (Figure 1).
Conclusions: Visceral aortic dilation is common after infrarenal aortic repair. Visceral aortic thrombus present prior to infrarenal AAA repair and endovascular repair is associated with an increased risk of future aortic aneurysm development after infrarenal AAA repair. These factors may predict future failures for complex juxtarenal repairs with ChEVAR and FEVAR.
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