Vasc Spec Int.  2021 Dec;37(4):34. 10.5758/vsi.210035.

Incidence and Risk Factors for Sac Expansion after Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms

• Hwang D
• Kim HK
• Huh S

• KMID: 2524486
• DOI: http://doi.org/10.5758/vsi.210035

Abstract

Purpose
This study aimed to examine the sac changes after endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms.
Materials and Methods
We examined the aneurysm sac size initially and regularly after surgery in 157 consecutive patients who underwent EVAR in 2009-2019. Contrast-enhanced computed tomography (CT) scans were used as well as ultrasound images with non-enhanced CT scans in the patients with renal insufficiency. Sac expansion (SE) at 3 years was divided into two categories: progressive SE (PSE) defined as continuous sac enlargement of ≥5 mm on serial follow-up images at 1 and 3 years compared with the initial sac and delayed SE (DSE) defined as re-expansion of ≥5 mm compared with the regressed or stable sac at 1 year. The SE rate at 1 and 3 years and the risk factors for SE at 3 years were analyzed using logistic regression.
Results
During a median follow-up of 32.5 months, nine reinterventions in six patients were performed with open conversion (n=5) and endovascular repair (n=4). At 1 year, 112 patients underwent follow-up imaging. SE and sac regression were noted in 4 (3.6%) and 57 (50.9%) patients, respectively. Of the 64 patients with 3-year follow-up images, 16 (25%) exhibited SE (PSE [n=6] and DSE [n=10]). In the multivariable analysis, the risk factors for overall SE at 3 years were endoleaks at 1 year (P=0.006) and renal insufficiency (P=0.003).
Conclusion
During post-EVAR follow-up, patients with any endoleak at 1 year or renal insufficiency must be strictly monitored for SE development.

Keyword

Endovascular aneurysm repair (EVAR); Sac expansion; Risk factors; Renal insufficiency; Endoleak