title: Influencing factors of sac shrinkage after endovascular aneurysm repair.
abstract: Sac shrinkage is considered a reliable surrogate marker of success after endovascular aneurysm repair (EVAR). Whereas sac shrinkage is the best expected outcome, predictive factors of sac shrinkage remain unclear. The aim of this study was to identify the role of preoperative and postoperative influencing factors of sac reduction after EVAR.
  
  
  
  Online searches across MEDLINE, Embase, and Cochrane Library medical databases were simultaneously performed. Study effects were pooled using a random-effects model, and forest plots were generated for every potential influencing factor.
  
  
  
  A total of 24 studies with 14,754 patients were included (mean age, 73.4 years; 76% male). At a mean follow-up of 24 months, the pooled shrinkage proportion was 47%. Random-effects meta-analysis revealed that renal impairment (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.57-0.96), type I endoleaks (OR, 0.17; 95% CI, 0.08-0.39), type II endoleaks (OR, 0.21; 95% CI, 0.14-0.33), and combined type I and type II endoleaks (OR, 0.32; 95% CI, 0.22-0.47) were found to prevent sac shrinkage, whereas hypercholesterolemia (OR, 1.24; 95% CI, 1.02-1.51) and smoking (OR, 1.32; 95% CI, 1.17-1.49) have a significant positive impact on sac shrinkage. In addition, there was a trend toward the association between shrinkage and statin therapy (OR, 4.07; 95% CI, 1.02-16.32) and nearly significant negative impacts of coronary artery disease (OR, 0.84; 95% CI, 0.70-1.01), diabetes (OR, 0.79; 95% CI, 0.60-1.04), and sac thrombus (OR, 0.88; 95% CI, 0.77-1.01) on sac shrinkage.
  
  
  
  In this large meta-analysis of patients undergoing EVAR, we found that several comorbidity and postoperative factors were associated with postoperative sac shrinkage. These findings may contribute to a better understanding of the shrinkage process of patients undergoing EVAR.
authors.affiliation: Therenva, Rennes, France. Electronic address: florent.lalys@therenva.com.
authors.forename: Florent
authors.initials: F
authors.lastname: Lalys
authors.affiliation: INSERM U1099, Rennes, France; Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France; Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Daoudal
authors.affiliation: INSERM U1099, Rennes, France; Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France; ANSYS, Villeurbanne, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Gindre
authors.affiliation: Therenva, Rennes, France.
authors.forename: Cemil
authors.initials: C
authors.lastname: Göksu
authors.affiliation: INSERM U1099, Rennes, France; Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France; Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lucas
authors.affiliation: INSERM U1099, Rennes, France; Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France; Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Kaladji
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D015897:Comorbidity; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012074:Remission Induction; D012307:Risk Factors; D016896:Treatment Outcome