title: Aneurysm Sac Enlargement after Endovascular Abdominal Aortic Aneurysm Repair.
abstract: The aim of this study is to give an overview of current knowledge regarding abdominal aortic aneurysm (AAA) growth after endovascular aortic aneurysm repair (EVAR) that could potentially lead to aortic rupture. A search on Pubmed was performed. A total of 705 articles were found after initial search, of which 49 were included in the final selection. Reports on the incidence of aneurysm enlargement after EVAR vary between 0.2% and 41%. Continuous growth could lead to rupture of the aneurysm sac. There are several supposed risk factors for growth after EVAR. Endoleaks remain a hot topic as these could lead to persistent pressurization of the aneurysm sac causing growth. Various types of endoleak exist, of which each kind requires an individual treatment approach, other risk factors for aneurysm growth include endotension and the use of EVAR outside instructions for use (IFU). Reinterventions after EVAR are common; however, it is unclear how frequently these are required because of aneurysm enlargement. Aneurysm enlargement after EVAR remains a subject of debate, as this could lead to aortic rupture. This emphasizes the need for life-long radiologic surveillance during follow-up. Aortic growth after EVAR is often a result of endoleak; however, in some cases, no endoleak is detectable. Endoleak in combination with aortic growth >5 mm generally requires reintervention. A cause of concern is the liberal use of endovascular devices outside the IFU that may result in increased risk of AAA growth after EVAR.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Amsterdam, the Netherlands. Electronic address: s.a.dingemans@amc.uva.nl.
authors.forename: Siem A
authors.initials: SA
authors.lastname: Dingemans
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Frederik H W
authors.initials: FH
authors.lastname: Jonker
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Amsterdam, the Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Amsterdam, the Netherlands.
authors.forename: Joost A
authors.initials: JA
authors.lastname: van Herwaarden
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D012086:Reoperation; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome