title: Influence of type II endoleak volume on aneurysm wall pressure and distribution in an experimental model.
abstract: OBJECTIVE
  We have previously shown that type II endoleak size is a predictor of aneurysm growth after aortic endografting. To better understand this observation, we investigated the influence of endoleak size on pressure transmitted to the aneurysm wall and its distribution within the aneurysm sac.
  
  
  METHODS
  In an ex vivo model, an artificial aneurysm sac was incorporated within a mock circulation comprised of rubber tubing and a pulsatile pump. Three strain-gauge pressure transducers were placed in the aneurysm wall at different locations, including the site of maximum aneurysm diameter. The aneurysm was filled with either human aneurysm thrombus or dough that mimicked thrombus and simulated type II endoleaks of varying volumes (1 to 10 mL) were created. Aneurysm wall pressure (AWP) measurements were recorded at mean arterial pressures (MAPs) of 60, 80, and 100 mm Hg. Correlation coefficients ( r ) and analysis of variance were used to assess the relationship between endoleak volume and AWP.
  
  
  RESULTS
  Increasing endoleak volume '3 cm 3 resulted in proportionally increased AWP at all levels of MAP and at all sites, with highest pressures recorded at the site of the maximum aneurysm diameter (r = 0.83 when MAP = 100 mm Hg; r = 0.85 when MAP = 80 mm Hg; r = 0.88 when MAP = 60 mm Hg; P < .001). AWP plateaued when the endoleak volume was >3 cm 3 . Pressure distribution within the sac was not uniform. Although the difference was within +/-10%, statistically significant higher AWPs were observed at the site of maximum aneurysm diameter (P <.001). AWP also correlated with MAP.
  
  
  CONCLUSIONS
  Increasing type II endoleak volume results in proportionally higher AWP, which is greatest at the site of maximum aneurysm diameter. This study confirms the clinical observation that type II endoleak volume and MAP may be important predictors of aneurysm expansion.
  
  
  CONCLUSIONS
  Our experimental model of a type II endoleak revealed that endoleak size is a significant factor that influences the magnitude of pressure transmission into the aneurysm wall. Increasing volume of the endoleak nidus was associated with proportionally higher aneurysm sac pressures. This mechanism may, in fact, account for the increased risk of aneurysm expansion observed in our clinical experience, thereby suggesting the need for more aggressive surveillance and possibly earlier intervention for patients with larger endoleaks.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Timaran
authors.forename: Takao
authors.initials: T
authors.lastname: Ohki
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
authors.forename: Evan C
authors.initials: EC
authors.lastname: Lipsitz
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Gargiulo
authors.forename: Soo J
authors.initials: SJ
authors.lastname: Rhee
authors.forename: Mahmood B
authors.initials: MB
authors.lastname: Malas
authors.forename: William D
authors.initials: WD
authors.lastname: Suggs
authors.forename: John P
authors.initials: JP
authors.lastname: Pacanowski
mesh_terms: D000783:Aneurysm / Q000503:physiopathology* / Q000601:surgery; D017130:Angioplasty; D001794:Blood Pressure / Q000502:physiology*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D008955:Models, Cardiovascular; D011183:Postoperative Complications; D011475:Prosthesis Failure; D011673:Pulsatile Flow / Q000502:physiology; D012720:Severity of Illness Index