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Aneurysm sac behavior following endovascular aneurysm repair using a branched stent graft
Dhanakom Premprabha, MD, Timothy A.M. Chuter, MD, Linda M. Reilly, MD., Julia D. Sobel, BS., Chris Pua, PhD., Karen C. Chong, BS., Jade S. Hiramoto, MD..
University of California San Francisco, San Francisco, CA, USA.

Objective: To measure changes in aortic diameter and volume following aneurysm repair using a multi-branched thoracoabdominal stent graft.
Method: Between September 2005 and May 2013, 120 patients underwent aneurysm repair using multi-branched thoracoabdominal stent-grafts. Follow-up included routine CT at 1, 6 and 12 months and yearly thereafter. We retrospectively compared the initial post-operative CTA to subsequent CTA using three-dimensional analysis to measure changes in the maximum diameter of the aneurysm and the volume of aorta encompassed by the stent graft.
Results: 91 patients had adequate CTA for serial measurement of aneurysm diameter. Mean follow-up was 23.05+17.37 months. Comparing the first CTA with the most recent CTA, 52 patients (57.14%) had > 5 mm diameter decrease, 39 (42.86%) had < 5 mm change, and none had > 5 mm increase. 47 patients had adequate CTA for serial measurement of aortic volume. Of these, 35 (74.47%) had > 5% decreased in aortic volume, 9 (19.15%) had < 5% change, and 3 (6.38%) had > 5% increase. In the same group of 47 patients, diameter decreased in 32 (68%) and remained stable in 15 (32%). This small difference in the frequency of aneurysm size change (up or down) between volume-based and diameter-based measurements was not significant. The correlation between volume change and diameter change was significant (p=0.006) but weak (R2=0.16). 26 patients (28.5%) had 30 endoleaks (Type I = 6, Type II = 19, Type III = 5). The prevalence of diameter decrease was slightly lower in patients with endoleaks than patients without. The effect of endoleak on diameter might have been more significant had direct endoleaks (types I and III) not been treated. In 3 cases endoleak treatment was delayed by uncertainty regarding the source. In all 3, initial aneurysm dilatation was followed by shrinkage. The failed treatment of a type I endoleak in a case of aorto-iliac dissection resulted in the only case of rupture in the entire series. Type II endoleaks were not treated.
Conclusion: Persistent aneurysm dilatation was a rare event after endovascular repair using a multi-branched endovascular stent graft, probably because most direct endoleaks (types I and III) were treated, while untreated type II endoleaks appear to have had little effect on aneurysm size.


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