title: Successful treatment of endotension and aneurysm sac enlargement with endovascular stent graft reinforcement.
abstract: Abdominal aortic aneurysm (AAA) enlarges after successful endovascular repair because of endoleak, which is persistent blood flow within the aneurysm sac. In the absence of detectable endoleak, AAA may still expand, in part because of endotension, which is persistent pressurization within the excluded aneurysm. We report three patients who underwent successful endovascular AAA repair using the Excluder device (W. L. Gore & Associates, Flagstaff, Ariz). Although their postoperative surveillance showed an initial aneurysm regression, delayed aneurysm enlargement developed in all three, apparently due to endotension. Endovascular treatment was performed in which endograft reinforcement with a combination of aortic cuff and iliac endograft extenders were inserted in the previously implanted stent grafts. The endograft reinforcement procedure successfully resulted in aneurysm sac regression in all three patients. Our study underscores the significance of increased graft permeability as a mechanism of endotension and delayed aneurysm enlargement after successful endovascular AAA repair. In addition, our cases illustrate the feasibility and efficacy of an endovascular treatment strategy when endotension and aneurysm sac enlargement develops after endovascular AAA repair.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Hospital, 2002 Holcomb Boulevard, Houston, TX 77030, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kougias
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lin
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.forename: W Anthony
authors.initials: WA
authors.lastname: Lee
authors.forename: Hosam F
authors.initials: HF
authors.lastname: El Sayed
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011183:Postoperative Complications / Q000601:surgery; D011312:Pressure; D011474:Prosthesis Design; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome