Hypertension Is Associated With Aneurysm Sac Expansion In Type Ii Endoleak Following Evar
Patricia O. Yau, M.D.1, Charles DeCarlo, M.D.2, Maria Coluccio, M.D.1, Adele Heib, B.S.1, John Skendelas, M.D.1, Evan Lipsitz, M.D.1, Saadat Shariff, M.D.1.
1Montefiore Medical Center, Bronx, NY, USA, 2Massachusetts General Hospital, Boston, MA, USA.
OBJECTIVES: Type II endoleaks occur in up to 40% of patients following endovascular repair of abdominal aortic aneurysm (EVAR). Type II endoleaks with sac enlargement require intervention, while predictors of this sac expansion have not been well elucidated. Based on our observations, we sought to determine whether hypertension was associated with aneurysm sac expansion.
METHODS: Patients with type II endoleak following EVAR at a single institution from 2005-2020 were identified from a prospectively collected institutional database. Postoperative imaging, including duplex ultrasound and/or computed tomography (CT) scans, were reviewed. Hypertension was defined as a diagnosis in the medical record with use of pharmacologic anti-hypertensive. The primary outcome was change in aneurysm sac diameter over time. Secondary outcomes included: need for reintervention, rupture, and resolution of endoleak. Changes in sac diameter were modeled using a linear mixed effects model.
RESULTS: Of 288 consecutive EVAR patients, there were 41 (14.2%) type II endoleaks. Twenty-nine patients had follow-up imaging after endoleak diagnosis and were included in the analysis. There were 85 total studies available in this cohort with a median follow-up of 1.7 years (IQR: 1.0-2.1 years). EVAR was performed electively in 23 (79.3%) patients, for symptomatic aneurysm in 5 (17.2%), and for rupture in one (3.4%). Twenty-one patients (72.4%) had hypertension. Hypertension was associated with a +4.3 mm/yr increase in sac growth (95%CI: 1.0-7.6 mm/year; p=0.011). There were 14 reinterventions for endoleak in 10 patients with hypertension. The 8 patients without hypertension demonstrated sac shrinkage (-2.1 mm/yr; 95%CI:-5.0 to 0.8 mm/yr); there were no reinterventions in this group. One patient ruptured during follow-up, resulting in mortality. Twelve patients had resolution of endoleak during follow-up; four after intervention, and eight without. After adjusting for age, aneurysm sac diameter, smoking history, and statin use, hypertension was independently associated with increased sac growth (increase of +4.0 mm/yr; 95%CI: 0.3-7.7; p=0.03).
CONCLUSIONS: Hypertension was associated with sac expansion while the absence of hypertension was associated with sac shrinkage in patients with type II endoleak. Further studies are needed to determine whether optimization of blood pressure control may minimize the incidence of sac expansion and endoleak-related adverse events.
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