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Early Sac Volume Changes Predict Long-Term Diameter Sac Dynamics After Infrarenal EVAR
Camila R. Guetter, MD MPH1, Jeremy D. Darling, MD
1, Isa Van Galen, MD
1, Jemin Park, MD
1, Michael Ciaramella, MD
1, Ahmed M. Mahmoud, PhD
2, Salvatore T. Scali, MD
3, David H. Stone, MD
4, Bjoern D. Suckow, MD MS
4, Marc L. Schermerhorn, MD
1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA,
2Astute Imaging Inc., Kirkland, WA, USA,
3University of Florida, Gainesville, FL, USA,
4Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
OBJECTIVES: Following EVAR, early analyses suggest that volume may detect sac changes sooner than diameter. We compared sac volume and diameter in characterizing sac dynamics following EVAR.
METHODS: We retrospectively analyzed patients who underwent infrarenal EVAR utilizing Astute Medical data. Inclusion required a preoperative scan, an initial postoperative scan, and ≥1 subsequent scan. Dates of subsequent scans were categorized relative to prior scans, as the exact date of operation was unavailable. Sac dynamics were assessed by maximum aortic diameter and volume (lowest renal to aortic bifurcation), with regression/expansion defined as diameter change
>5mm and volume change
>5%. Endoleak presence was also captured. We compared sac dynamics in terms of diameter and volume thresholds at 1 year, and then longer-term at 2-5 years.
RESULTS: 5,667 patients and 29,778 scans (mean 5.3+/-2.5) were included. Patients were predominantly male (85%), with mean age 73.7+/-8.2 years. One year postoperatively, diameter measurements classified 56% aneurysms as stable, 36% as regressed, and 8.2% as expanded. In contrast, volumetric assessment classified 20% as stable, 53% as regressed, and 27% as expanded. Of those with diameter stability but volume regression at 1 year, 44% later had diameter regression at 5 years (Figure). Of those with diameter regression at 1 year, 81% still had regression at 5 years. In contrast, those with stable diameter but volume expansion at 1 year demonstrated progressive risk of later diameter expansion, with 51% expansion at 5 years. Sac dynamics from 2-5 years differed significantly by presence of endoleak at the initial postoperative scan, with a 1.36-fold increased likelihood of expansion at 5 years for those with stable diameter and volume expansion (59.3% vs 43.5%,
P<0.001), and a 0.42-fold likelihood of regression at 5 years for those with stable diameter and volume regression (20% versus 47.3%,
P<0.001).
CONCLUSIONS: Volume measurements are more sensitive for detecting early regression and expansion and were highly associated with future diameter changes. As the availability of easy volume calculation develops, this should become the routine in the surveillance of EVAR patients to improve early detection of patients meeting criteria for reintervention, particularly in the presence of endoleak.
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