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Comparative Sac Dynamics Between Patients Undergoing EVAR With SHAPE Memory Versus Standard EVAR
Elisa Caron, MD1, Emily St John, BS
1, Camila R. Guetter, MD, MPH
1, Jemin Park, MD
1, Jeremy Darling, MD
1, Andrew Holden, FRANZCR
2, Andrew Hill, MBChB, FRACS
3, Michel Reijnen, MD, PhD
4, Jan Heyligers, MD, PhD
5, Manar Khashram, MBChB, PhD, FRACS
6, Arno Wiersema, MD, PhD
7, Marc Schermerhorn, MD
1.
1Beth Israel Deconess Medical Center, Boston, MA, USA,
2Department of Interventional Radiology Auckland City Hospital, Auckland, New Zealand,
3Department of Vascular Services Auckland City Hospital, Auckland, New Zealand,
4Department of Surgery, Rijnstate, Arnhem and the Multi-Modality Medical Imaging Group, Enschede, Netherlands,
5Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands,
6Department of Vascular and Endovascular Surgery Waikato Hospital, Waikato, New Zealand,
7Department of Vascular Surgery Dijklander Ziekenhuis, Hoorn, Netherlands.
Objective: Sac regression following EVAR for AAA is associated with improved survival. Shape Memory Polymer (SMP) demonstrated favorable results for regression in preliminary trials, and a randomized controlled trial is still ongoing. As such, our goal was to compare sac dynamics following EVAR using SMP (SMP EVAR) to standard EVAR.
Methods: We obtained data from the early feasibility study of SMP from New Zealand and the Netherlands, as well as patients who were treated with SMP at our institution, and compared them to patients undergoing standard EVAR at our institution.
To align with trial criteria, patients were excluded if their initial diameter was <5cm in women or <5.5cm in men, had an iliac artery aneurysm, presented as ruptured, had severe CAD, serum creatinine of >2.5mg/dl, or underwent repair with stentgrafts other than the Gore Excluder and Medtronic Endurant II. Inverse probability of treatment weighting was used to account for differences in preoperative diameter, age, sex, smoking, diabetes, and BMI. We compared 1-year sac dynamics between the weighted groups, using two logistic regression models with stable as the referent.
Results: In a cohort of 166 patients, 128 underwent standard EVAR and 38 underwent SMP EVAR. There were no baseline differences in comorbidities, demographics, preoperative diameter (median: 58 vs. 59mm,
P=.33), or neck length (25 vs. 21 mm,
P=.69). Standard EVAR had 1.4% expansion, 38% regression, and 61% stable compared to 0%, 64%, and 36% of SMP EVAR. SMP EVAR was associated with higher odds of 1-year regression (aOR 3.72 [1.26-11],
P=.02). There was no difference in the odds of expansion (aOR 0.78 [0.00-32.1,]
P=0.9).
Conclusion: In this weighted cohort, compared to standard EVAR, SMP is associated with higher odds of 1-year sac regression. These data suggest that the use of SMP can help increase sac regression rates and potentially improve outcomes following EVAR.
Table 1: Weighted 1-year sac dynamics after standard EVAR compared to EVAR with SMP| Sac Category | EVAR | EVAR + SMP | aOR | 95% CI | p-value |
| Sac Expansion | 1 (1.4 %) | 0 (0%) | 0.78 | 0.00-32.1 | 0.9 |
| Sac Regression | 27 (38%) | 37 (64%) | 3.72 | 1.26-11 | 0.02 |
| Sac Stable | 44(61%) | 20 (36%) | 0.27 | 0.09-0.82 | 0.02 |
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