title: Preoperative predictive factors of aneurysmal regression using the reporting standards for endovascular aortic aneurysm repair.
abstract: BACKGROUND
  Aneurysmal regression is a reliable marker for long-lasting success after endovascular aneurysm repair (EVAR). The aim of this study was to identify the preoperative factors that can predictably lead to aneurysmal sac regression after EVAR, according to the reporting standards of the Society for Vascular Surgery and the International Society of Cardiovascular Surgery (SVS/ISCVS).
  
  
  METHODS
  From 199 patients treated by EVAR between 2000 and 2009, 164 completed computed tomography angiographies and duplex scan follow-up images were available. All computed tomography angiographies for enrolled patients in this retrospective study were analyzed with Endosize software (Therenva, Rennes, France) to provide spatially correct 3-dimensional data in accordance with SVS/ISCVS recommendations. Anatomic parameters were graded according to the relevant severity grades. A severity score was calculated at the aortic neck, the abdominal aortic aneurysm, and the iliac arteries. Clinical and demographic factors were studied. Patients with aneurysmal regression >5 mm were assigned to group A (mean age, 71.4 ± 8.9 years) and the others to group B (76.3 ± 8.3 years).
  
  
  RESULTS
  Aneurysmal regression occurred in 66 patients (40.2%; group A). Univariate analyses showed smaller severity scores at the aortic neck (P = .02) and the iliac arteries (P = .002) in group A and calcifications and thrombus were less significant at the aortic neck (P = .003 and P = .02) and at the iliac arteries (P = .001 and P = .02), and inferior mesenteric artery patency was less frequent (68.2% vs 82.7%, P = .04). Two multivariate analyses were done: one considered the scores and the other the variables included in the scores. In the first, the patients of group A were younger (P = .002) and aortic neck calcifications were less significant (P = .007). In the second, group A patients were younger (P < .001) and the aortic neck scores were smaller (P = .04). There was no difference between the two groups in the type of implanted endoprosthesis or in the follow-up (group A: 46.4 ± 24 months; group B: 47.2 ± 22 months; P = .35).
  
  
  CONCLUSIONS
  In this study, the young age of the patients and their aortic neck quality, in particular the absence of neck calcification, appear to have been the main factors affecting aneurysm shrinkage, such that they represent a target population for the improvement of EVAR results.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, CHU Rennes, Rennes, France. kaladrien@hotmail.fr
authors.forename: Adrien
authors.initials: A
authors.lastname: Kaladji
authors.forename: Alain
authors.initials: A
authors.lastname: Cardon
authors.forename: Issam
authors.initials: I
authors.lastname: Abouliatim
authors.forename: Boris
authors.initials: B
authors.lastname: Campillo-Gimenez
authors.forename: Jean François
authors.initials: JF
authors.lastname: Heautot
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography / Q000592:standards*; D001807:Blood Vessel Prosthesis / Q000592:standards; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D019984:Quality Indicators, Health Care / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000592:standards*; D016896:Treatment Outcome