Aneurysm morphology as a predictor of endoleak following endovascular aortic aneurysm repair: do smaller aneurysm have better outcomes?
Since the Food and Drug Administrations' approval of endovascular devices for abdominal aortic aneurysm (AAA) repair, clinicians have been relaxing the strict inclusion criteria present during the clinical trials. Although the long-term natural history of endoleaks remains unclear, attachment site leaks (type I) are believed to represent an ongoing risk for future rupture. We reviewed our experience with endovascular AAA repair to elucidate factors that predispose toward the development of endoleaks and found that larger AAAs are significantly more likely to have a short proximal neck and severe proximal angulation. These factors likely contribute to the significantly increased rate of type I endoleaks that occurred after endovascular repair of large AAAs. Small AAAs (<5) had the lowest rate of endoleaks overall (8.3%) and of type I endoleaks in particular (0%). We conclude that AAA size and morphology can be used to predict which aneurysms will experience attachment site endoleaks in their course; AAAs from 4.5 to 5 cm in diameter may be particularly well suited for endovascular repair in this regard.
Rockman
Caron B
CB
Division of Vascular Surgery, New York University Medical Center, New York, NY 10016, USA. caron.rockman@msnyuhealth.org
Lamparello
Patrick J
PJ
Adelman
Mark A
MA
Jacobowitz
Glenn R
GR
Therff
Sonya
S
Gagne
Paul J
PJ
Nalbandian
Matthew
M
Weiswasser
Jonathan
J
Landis
Ronnie
R
Rosen
Robert
R
Riles
Thomas S
TS
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000592:standards; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012955:Societies, Medical; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000592:standards; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000592:standards