European Radiology

, Volume 18, Issue 5, pp 957–965

Aortic aneurysm sac pressure measurements after endovascular repair using an implantable remote sensor: initial experience and short-term follow-up

  • Hanno Hoppe
  • Jocelyn A. Segall
  • Timothy K. Liem
  • Gregory J. Landry
  • John A. Kaufman
Vascular-Interventional

Abstract

The purpose of this single-center study was to report our initial experience with an implantable remote pressure sensor for aneurysm sac pressure measurement in patients post-endovascular aneurysm repair (EVAR) including short-term follow-up. A pressure sensor (EndoSure, Atlanta, GA) was implanted in 12 patients treated with different commercially available aortic endografts for EVAR. Pressure was read pre- and post-EVAR in the operating room. One-month follow-up (30 days ± 6 days) was performed including sac pressure readings and IV contrast CT scans. Variables were compared using the paired Student’s t test. An intraprocedure type-I endoleak and a type-III endoleak were successfully treated resulting in decreasing sac pressures. In all patients, post-EVAR systolic sac pressure decreased by an average of 33% (P ≤ 0.005) compared to pre-EVAR measurements. One-month follow-up demonstrated a 47% decrease in systolic sac pressure (P ≤ 0.05). On follow-up CT scans, the average maximum aneurysm diameter pre-EVAR was 6.3 ± 1.6 cm and post-EVAR 6.0 ± 1.7 cm (P≤0.05). The diameter of the aneurysm sac was larger only in one patient with a type-III endoleak. Remote sac pressure measurement may provide important information in addition to imaging and may help to reduce the number of follow-up CT scans.

Keywords

Aortic aneurysm Stent graft Pressure sensor 

References

  1. 1.
    Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson PL, Arons RR, Moskowitz AJ, Gelijns A, Magnell C, Faries PL et al. (2004) A statewide experience with endovascular abdominal aortic aneurysm repair: rapid diffusion with excellent early results. J Vasc Surg 39:10–19PubMedCrossRefGoogle Scholar
  3. 3.
    Marin ML, Hollier LH, Ellozy SH, Spielvogel D, Mitty H, Griepp R et al (2003) Endovascular stent graft repair of abdominal and thoracic aortic aneurysms: a 10-year experience with 817 patients. Ann Surg 238:586–593PubMedGoogle Scholar
  4. 4.
    Chuter T, Ivancev K, Malina M, Resch T, Brunkwall J, Lindblad B et al (1997) Aneurysm pressure following endovascular exclusion. Eur J Vasc Endovasc Surg 13:85–87PubMedCrossRefGoogle Scholar
  5. 5.
    Baum RA, Carpenter JP, Cope C, Golden MA, Velazquez OC, Neschis DG et al (2001) Aneurysm sac pressure measurements after endovascular repair of abdominal aortic aneurysms. J Vasc Surg 33:32–41PubMedCrossRefGoogle Scholar
  6. 6.
    Ohki T, Ouriel K, Silveira PG, Katzen B, White R, Criado F et al (2007) Initial results of wireless pressure sensing for endovascular aneurysm repair: The APEX Trial-Acute Pressure Measurement to Confirm Aneurysm Sac EXclusion. J Vasc Surg 45:236–242PubMedCrossRefGoogle Scholar
  7. 7.
    Sanchez LA, Faries PL, Marin ML, Ohki T, Parsons RE, Marty B et al (1997) Chronic intraaneurysmal pressure measurement: an experimental method for evaluating the effectiveness of endovascular aortic aneurysm exclusion. J Vasc Surg 26:222–230PubMedCrossRefGoogle Scholar
  8. 8.
    Pacanowski JP, Stevens SL, Freeman MB, Dieter RS, Klosterman LA, Kirkpatrick SS et al (2002) Endotension distribution and the role of thrombus following endovascular AAA exclusion. J Endovasc Ther 9:639–651PubMedCrossRefGoogle Scholar
  9. 9.
    Vallabhaneni SR, Gilling-Smith GL, Brennan JA, Heyes RR, Hunt JA, How TV et al (2003) Can intrasac pressure monitoring reliably predict failure of endovascular aneurysm repair? J EndovascTher 10:524–530CrossRefGoogle Scholar
  10. 10.
    Faries PL, Sanchez LA, Marin ML, Parsons RE, Lyon RT, Oliveri S et al (1997) An experimental model for the acute and chronic evaluation of intra-aneurysmal pressure. J EndovascSurg 4:290–297CrossRefGoogle Scholar
  11. 11.
    Treharne GD, Loftus IM, Thompson MM, Lennard N, Smith J, Fishwick G et al (1999) Quality control during endovascular aneurysm repair: monitoring aneurysmal sac pressure and superficial femoral artery flow velocity. J Endovasc Surg 6:239–245PubMedCrossRefGoogle Scholar
  12. 12.
    Sonesson B, Dias N, Malina M, Olofsson P, Griffin D, Lindblad B et al (2003) Intra-aneurysm pressure measurements in successfully excluded abdominal aortic aneurysm after endovascular repair. J Vasc Surg 37:733–738PubMedCrossRefGoogle Scholar
  13. 13.
    Mozes G, Kinnick RR, Gloviczki P, Bruhnke RE, Carmo M, Hoskin TL et al (2005) Noninvasive measurement of aortic aneurysm sac tension with vibrometry. J Vasc Surg 42:963–971PubMedCrossRefGoogle Scholar
  14. 14.
    Ellozy SH, Carroccio A, Lookstein RA, Minor ME, Sheahan CM, Juta J et al (2004) First experience in human beings with a permanently implantable intrasac pressure transducer for monitoring endovascular repair of abdominal aortic aneurysms. J Vasc Surg 40:405–412PubMedCrossRefGoogle Scholar
  15. 15.
    Chaer RA, Trocciola S, DeRubertis B, Hynecek R, Xu Q, Lam R et al (2006) Evaluation of the accuracy of a wireless pressure sensor in a canine model of retrograde-collateral (type II) endoleak and correlation with histologic analysis. J Vasc Surg 44:1306–1313PubMedCrossRefGoogle Scholar
  16. 16.
    Golzarian J, Valenti D (2006) Endoleakage after endovascular treatment of abdominal aortic aneurysms:Diagnosis, significance and treatment. Eur Radiol 16:2849–2857PubMedCrossRefGoogle Scholar
  17. 17.
    Springer F, Schlierf R, Pfeffer JG, Mahnken AH, Schnakenberg U, Schmitz-Rode T (2007) Detecting endoleaks after endovascular AAA repair with a minimally invasive, implantable, telemetric pressure sensor: an in vitro study. Eur Radiol 17:2589–2597PubMedCrossRefGoogle Scholar
  18. 18.
    Veith FJ, Baum RA, Ohki T, Amor M, Adiseshiah M, Blankensteijn JD et al (2002) Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg 35:1029–1035PubMedCrossRefGoogle Scholar
  19. 19.
    Hinchcliffe RJ, Singh-Ranger R, Davidson IR, Hopkinson BR (2001) Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur J Vasc Endovasc Surg 22:663–665Google Scholar
  20. 20.
    Imamura A, Roike Y, Iwaki R, Saito T, Ozaki T, Yamada HT, Kamiyama Y (2005) Infrarenal Abdominal Aortic Aneurysm Complicated by Persistent Endotension After Endovascular Repair: Report of a Case. Surg Today 35:879–882PubMedCrossRefGoogle Scholar
  21. 21.
    Wain RA, Marin M.L, Ohki T, Sanchez LA, Lyon RT, Rozenblit A et al (1998) Endoleaks after endovascular graft treatment of aortic aneurysm: classification, risk factors, and outcome. J Vasc Surg 27:69–80PubMedCrossRefGoogle Scholar
  22. 22.
    Gilling-Smith G, Brennan J, Harris P, Bakran A, Gould D, McWilliams R (1999) Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention. J Endovasc Surg 6:305–307PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2007

Authors and Affiliations

  • Hanno Hoppe
    • 1
  • Jocelyn A. Segall
    • 2
  • Timothy K. Liem
    • 2
  • Gregory J. Landry
    • 2
  • John A. Kaufman
    • 1
  1. 1.Dotter Interventional Institute, Oregon Health & Science UniversityPortlandUSA
  2. 2.Department of Vascular SurgeryOregon Health & Science UniversityPortlandUSA

Personalised recommendations