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Do Patent Aortic Side Branches Affect Aneurysm Sac Growth?
David J. Dexter, MD, Caron Rockman, MD, Mark A. Adelman, MD, Firas Mussa, MD, Neal Cayne, MD, Todd Berland, MD, Frank Veith, MD, Thomas Maldonado, MD.
New York University, New York, NY, USA.

Objectives:
Endoleak and sac growth remain unpredictable occurrences following EVAR. This study was designed to evaluate the impact of patent Inferior Mesenteric Artery and Lumbar Arteries on aneurysm sac behavior after EVAR.
Methods:
Pre-and postoperative CT scans from 133 abdominal aortic aneurysms treated with EVAR were analyzed. The status of all Lumbar Arteries and the IMA were evaluated for patency and size. Sac change was defined as a >2.5mm difference in diameter when compared to preoperative measurements.
Results:
The number of patent lumbars was highly predictive of endoleak (1-3=6.7%, 4-6=35.6%, 7-9=57.8%, p<.05), as was the presence of a patent IMA (45.4% vs. 3.1%, p<.05). The size of patent lumbars was not predictive of endoleak. Patients with at least one patent lumbar artery >3mm were more likely to experience sac diameter growth postoperatively (28.4% vs. 11.4%, p<.05). Similarly, patients with a patent IMA on preoperative CT were more likely to experience sac growth, although this did not reach statistical significance (26% vs. 11%, p=.08). The more patent lumbar arteries preoperatively, the more likely a patient experienced sac growth postoperatively (1-3=1%, 4-9=21%, p=.06). Multivariate analysis showed that the number of patent lumbar arteries was an independent predictor of sac growth postoperatively.
Conclusions:
The presence of patent lumbars, and patent IMA on preoperative imaging appears to be associated with a post-operative endoleak, and an increase in sac diameter. Aneurysms with fewer patent lumbar arteries, smaller arteries and occluded IMA are less likely to grow and may require less vigilant postoperative imaging. Similarly, preoperative patients with a patent IMA, patent lumbar artery >3mm in diameter, or at least 4 patent lumbar arteries, can be considered for preoperative embolization of these vessels, as these patients have a high chance of experiencing endoleak and sac growth which will may require intervention.


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