title: Comparison of Early Sac Shrinkage with Third-Generation Stent Grafts for Endovascular Aneurysm Repair.
abstract: OBJECTIVE
  To compare the effects of the currently most-used third-generation stent grafts on early aneurysm sac shrinkage, a proposed marker of successful endovascular aneurysm repair (EVAR).
  
  
  METHODS
  EVARs performed from 2009 to 2013 at 2 institutions were retrospectively analyzed. Patients treated with a Zenith, EXCLUDER, or Endurant device who completed imaging studies before EVAR and at 1, 6, 12, and 24 months afterward were included. Sac shrinkage was compared by volumetry.
  
  
  RESULTS
  Among 296 EVAR procedures, 47 were excluded for the use of different stent grafts and 87 for loss to follow-up or missing required imaging study, leaving 162 EVAR procedures (69 Zenith, 54 EXCLUDER, and 39 Endurant devices) for analysis. Mixed-effects model analysis revealed that the use of a Zenith device resulted in significantly greater shrinkage compared with EXCLUDER and Endurant devices (both P < .001). The differences were statistically significant from 1 month after EVAR (average sac shrinkage at 1 mo for Zenith, EXCLUDER, and Endurant devices of 95.3%, 100.3%, and 102.6%, respectively), indicating an early shrinkage advantage for Zenith devices. In addition, multivariate analysis revealed Zenith device use to be a sole beneficial factor for sac shrinkage at 24 months after EVAR (odds ratio, 2.881; 95% confidence interval, 1.331-6.235; P = .007). Repeat intervention rates (all for treatment of type II endoleaks) for Zenith, EXCLUDER, and Endurant devices were 2.9% (2 of 69), 1.9% (1 of 54), and 2.6% (1 of 39), respectively.
  
  
  CONCLUSIONS
  Zenith device use was associated with significantly better early sac shrinkage. In view of the limited follow-up period, whether these differences lead to improved clinical outcomes remains unclear.
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Fujimura
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo, Japan. Electronic address: obara.z3@keio.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Obara
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Matsubara
authors.affiliation: Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Sekimoto
authors.affiliation: Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Harada
authors.affiliation: Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome