title: Treatment of post-implantation aneurysm growth by laparoscopic sac fenestration: long-term results.
abstract: OBJECTIVE
  Sac growth after endovascular aneurysm repair (EVAR) is an important finding, which may influence prognosis. In case of a type II endoleak or endotension, clipping of side branches and subsequent sac fenestration has been presented as a therapeutic alternative. The long-term clinical efficacy of this procedure is unknown.
  
  
  METHODS
  The study included eight patients who underwent laparoscopic aortic collateral clipping and sac fenestration for enlarging aneurysms following EVAR. Secondary interventions and clinical outcome were retrieved from hospital records. Sac behaviour was evaluated measuring volumes on periodical computed tomography angiography (CTA) imaging using dedicated software.
  
  
  RESULTS
  Follow-up had a median length of 6.6 (range 0.6-8.6) years. During this time, only three patients successfully achieved durable aneurysm shrinkage (n = 2) or stability (n = 1). The remaining patients suffered persistent (n = 2) or recurrent sac growth (n = 3), all regarded as failure of fenestration. A total of six additional interventions were performed, comprising open conversion (n = 2), relining (n = 1) and implantation of iliac extensions (n = 3). All additional interventions were successful at arresting further sac growth during the remainder of follow-up.
  
  
  CONCLUSIONS
  Despite being a less invasive alternative to conversion and open repair, the long-term outcome of sac fenestration is unpredictable and additional major procedures were often necessary to arrest sac growth.
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: Voûte
authors.forename: F M
authors.initials: FM
authors.lastname: Bastos Gonçalves
authors.forename: J M
authors.initials: JM
authors.lastname: Hendriks
authors.forename: R
authors.initials: R
authors.lastname: Metz
authors.forename: M R H M
authors.initials: MR
authors.lastname: van Sambeek
authors.forename: B E
authors.initials: BE
authors.lastname: Muhs
authors.forename: H J M
authors.initials: HJ
authors.lastname: Verhagen
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D018450:Disease Progression; D057867:Endoleak / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome