Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion.
OBJECTIVE
To relate changing abdominal aortic aneurysm (AAA) morphology after endovascular grafting to the presence of leakage, collateral perfusion, and other factors.


METHODS
Thirty-five patients who underwent successful AAA endovascular grafting were evaluated. Self-expanding Z-stents and Dacron grafts were applied in bifurcated and aortomonoiliac systems. Postoperative diameter changes were calculated from repeated spiral computed tomographic scans, angiograms, and ultrasonic phase-locked echo-tracking scans during a median 6-month follow-up (interquartile range [IQR] 3 to 12).


RESULTS
At 12 months, the diameters of completely excluded aneurysms had decreased 6 mm (IQR 2 to 11; p = 0.006). The proximal graft-anchoring stents had dilated 2 mm (IQR 0.5 to 3.3; p = 0.01). The aortic diameters immediately below the renal arteries but above the stents had not changed. Endoleakage and collateral perfusion (n = 13) were each associated with preserved aneurysm size and a 12 times higher risk of aneurysm dilation. After the leakage or the collateral perfusion had been treated, the aneurysm size decreased. Aneurysms with extensive intraluminal thrombi presented a reduced risk of leakage or perfusion.


CONCLUSIONS
The diameters of endovascularly excluded AAAs decrease, except in cases of leakage or perfusion. Careful follow-up of patients with aortic endografts is necessary.
Malina
M
M
Department of Vascular Surgery, Malmö University Hospital, Lund University, Sweden.
Ivancev
K
K
Chuter
T A
TA
Lindh
M
M
Länne
T
T
Lindblad
B
B
Brunkwall
J
J
Risberg
B
B
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D011093:Polyethylene Terephthalates