title: The burden of hard atherosclerotic plaques does not promote endoleak development after endovascular aortic aneurysm repair: a risk stratification.
abstract: OBJECTIVE
  To objectify the influence of the atherosclerotic burden in the proximal landing zone on the development of endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) using objective aortic calcium scoring (ACS).
  
  
  METHODS
  This retrospective observation study included 267 patients who received an aortic endograft between 1997 and 2010 and for whom preoperative computed tomography (CT) was available to perform ACS using the CT-based V600 method. The mean follow-up period was 2 ± 2.3 years.
  
  
  RESULTS
  Type I endoleaks persisted in 45 patients (16.9%), type II in 34 (12.7%), type III in 8 (3%), and type IV or V in 3 patients, respectively (1.1% each). ACS in patients with type I endoleaks was not increased: 0.029 ± 0.061 ml compared with 0.075 ± 0.1349 ml in the rest of the patients, (p > 0.05; Whitney-Mann U-Test). There were significantly better results for the indication "traumatic aortic rupture" than for the other indications (p < 0.05). In multivariate logistic regression analyses, age was an independent risk factor for the development of type I endoleaks in the thoracic aorta (Wald 9.5; p = 0.002), whereas ACS score was an independent protective factor (Wald 6.9; p = 0.009). In the abdominal aorta, neither age nor ACS influenced the development of endoleaks.
  
  
  CONCLUSIONS
  Contrary to previous assumptions, TEVAR and EVAR can be carried out without increasing the risk of an endoleak of any type, even if there is a high atherosclerotic "hard-plaque" burden of the aorta. The results are significantly better for traumatic aortic.
authors.affiliation: Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria. johannes.petersen@i-med.ac.at
authors.forename: Johannes
authors.initials: J
authors.lastname: Petersen
authors.forename: Bernhard
authors.initials: B
authors.lastname: Glodny
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D057867:Endoleak / Q000209:etiology*; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D055815:Young Adult