title: Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair.
abstract: To evaluate the association between aortic curvature and other preoperative anatomical characteristics and late (>1 year) type Ia endoleak and endograft migration in endovascular aneurysm repair (EVAR) patients.
  
  
  
  Eight high-volume EVAR centers contributed 116 EVAR patients (mean age 81±7 years; 103 men) to the study: 36 patients (mean age 82±7 years; 31 men) with endograft migration and/or type Ia endoleak diagnosed >1 year after the initial EVAR and 80 controls without early or late complications. Aortic curvature was calculated from the preoperative computed tomography scan as the maximum and average curvature over 5 predefined aortic segments: the entire infrarenal aortic neck, aneurysm sac, and the suprarenal, juxtarenal, and infrarenal aorta. Other morphological characteristics included neck length, neck diameter, mural neck calcification and thrombus, suprarenal and infrarenal angulation, and largest aneurysm sac diameter. Independent risk factors were identified using backward stepwise logistic regression. Relevant cutoff values for each of the variables in the final regression model were determined with the receiver operator characteristic curve.
  
  
  
  Logistic regression identified maximum curvature over the length of the aneurysm sac (>47 m-1; p=0.023), largest aneurysm sac diameter (>56 mm; p=0.028), and mural neck thrombus (>11° circumference; p<0.001) as independent predictors of late migration and type Ia endoleak.
  
  
  
  Aortic curvature is a predictor for late type Ia endoleak and endograft migration after EVAR. These findings suggest that aortic curvature is a better parameter than angulation to predict post-EVAR failure and should be included as a hostile neck parameter.
authors.affiliation: 1 Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.|2 Technical Medicine, Faculty of Science and Engineering, University of Twente, Enschede, the Netherlands.
authors.forename: Richte C L
authors.initials: RCL
authors.lastname: Schuurmann
authors.affiliation: 1 Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.|2 Technical Medicine, Faculty of Science and Engineering, University of Twente, Enschede, the Netherlands.
authors.forename: Kim
authors.initials: K
authors.lastname: van Noort
authors.affiliation: 1 Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.|2 Technical Medicine, Faculty of Science and Engineering, University of Twente, Enschede, the Netherlands.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Overeem
authors.affiliation: 3 Syntactx, New York, NY, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ouriel
authors.affiliation: 4 Department of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham, AL, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Jordan
authors.affiliation: 5 The Vascular Experts, Middletown, CT, USA.
authors.forename: Bart E
authors.initials: BE
authors.lastname: Muhs
authors.affiliation: 6 Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Yannick
authors.initials: Y
authors.lastname: 't Mannetje
authors.affiliation: 7 Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Reijnen
authors.affiliation: 8 Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
authors.forename: Bram
authors.initials: B
authors.lastname: Fioole
authors.affiliation: 9 Department of Vascular Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands.
authors.forename: Çağdaş
authors.initials: Ç
authors.lastname: Ünlü
authors.affiliation: 10 Department of Vascular Surgery, Franciscus Hospital, Roosendaal, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Brummel
authors.affiliation: 1 Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Jean-Paul P M
authors.initials: JPM
authors.lastname: de Vries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019540:Area Under Curve; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D012372:ROC Curve; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: abdominal aortic aneurysm; aneurysm diameter; angulation; aortic curvature; aortic neck; complications; endovascular aneurysm repair; geometry; migration; mural thrombus; stent-graft; type Ia endoleak