Intra-aneurysm sac pressure--the holy grail of endoluminal grafting of AAA.
OBJECTIVE
To relate intra-aneurysm sac pressure during endoluminal AAA repair to early and late endoleak, as well as to the aneurysm size upon follow-up.


METHODS
Prospective clinical investigation.


METHODS
In 46 patients who had their AAAs treated by a stent graft (group I), intra-operative pressure measurement was performed (aorta uni-iliac stent grafts: 25 cases, bifurcated stent grafts: 21 cases). In 18 patients with open repair (group II) flow in the inferior mesenteric artery, and the pressure in the aneurysm sac was measured, before and after aortic and iliac cross clamping. Values are given in median with range.


RESULTS
In group I, complete exclusion of AAA (no endoleak on intra-operative control angiogram) resulted in a statistically significant decrease in mean sac pressure from 74 (55-101) to 47 (4-104) mmHg. Pulse pressure reduced from 67 (34-103) to 8 (0-74) mmHg. In 11 patients a proximal type I endoleak was sealed by balloon modeling, after which the mean sac pressure reduced from 63 (14-91) to 52 (4-74) mmHg (n.s. versus patients with primary seal). Intra-operative pressure did not correlate with change in AAA diameter during twelve months follow-up. In group II, cross clamping of the proximal aorta significantly reduced mean sac pressure to 32 (21-55) mmHg, and the pulse pressure to 0 (0-13) mmHg (p < 0.05). Subsequent cross clamping of the iliac arteries did not significantly change the pressures.


CONCLUSIONS
Measurement of intra-aneurysm sac pressure can help to detect and treat endoleaks during endoluminal grafting. However, the intra-operative sac pressure did not predict the fate of aneurysm during follow up. Compared to open repair of AAA, the sac pressure after endoluminal grafting remains significantly higher, in relation to pulse pressure.
Gawenda
M
M
Vascular Centre of the University of Cologne, Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany.
Heckenkamp
J
J
Zaehringer
M
M
Brunkwall
J
J
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology* / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000503:physiopathology* / Q000601:surgery*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015607:Stents; D013997:Time Factors