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Surgery Today

, Volume 49, Issue 2, pp 130–136 | Cite as

Perioperative factors associated with aneurysm sac size changes after endovascular aneurysm repair

  • Daijiro HoriEmail author
  • Yohei Nomura
  • Taketo Yamauchi
  • Hiroshi Furuhata
  • Harunobu Matsumoto
  • Naoyuki Kimura
  • Koichi Yuri
  • Atsushi Yamaguchi
Original Article
  • 102 Downloads

Abstract

Purpose

To identify the perioperative factors associated with aneurysm size changes after endovascular aortic aneurysm repair (EVAR).

Methods

Between August, 2008 and December, 2014, 187 patients underwent EVAR treatment in our institution. The subjects of this study were 135 of these patients without peripheral artery disease, who were followed up with computed tomography (CT) for 3 years. Significant aneurysm size change was defined as sac size change of more than 5 mm from the baseline.

Results

Sac enlargement was identified in 25 patients (18.5%) and sac shrinkage was identified in 59 (43.7%) patients. The factors associated with sac enlargement were postoperative pulse wave velocity (OR: odds ratio 3.80, p = 0.047), prevalence of a type 2 endoleak 1 week after surgery (OR 4.26, p = 0.022), inner diameter (OR 1.10, p = 0.005), and distance from the lower renal artery to the terminal aorta (OR 1.05, p = 0.017). The factors associated with sac shrinkage were prevalence of a type 2 endoleak (OR 0.09, p < 0.001) and preoperative pulse wave velocity (OR 0.32, p = 0.022). The factors independently associated with type 2 endoleak were the use of an Excluder device (OR 3.99, p = 0.002) and the length of the aneurysm (OR 1.02, p = 0.027).

Conclusion

Inner diameter, treatment length, perioperative pulse wave velocity, and type 2 endoleak were associated with sac size changes after EVAR.

Keywords

EVAR Type 2 endoleak Pulse wave velocity Enlargement Shrinkage 

Notes

Acknowledgements

This study was supported by Jichi Medical University Young Investigator Award (DH).

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to disclose.

References

  1. 1.
    Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351:1607–18.CrossRefGoogle Scholar
  2. 2.
    Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364:843–8.CrossRefGoogle Scholar
  3. 3.
    Bastos Goncalves F, Baderkhan H, Verhagen HJ, Wanhainen A, Bjorck M, Stolker RJ, et al. Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair. Br J Surg. 2014;101:802–10.CrossRefGoogle Scholar
  4. 4.
    Kray J, Kirk S, Franko J, Chew DK. Role of type II endoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg. 2015;61:869–74.CrossRefGoogle Scholar
  5. 5.
    Aoki A, Suezawa T, Sangawa K, Tago M. Effect of type II endoleaks and antiplatelet therapy on abdominal aortic aneurysm shrinkage after endovascular repair. J Vasc Surg. 2011;54:947–51.CrossRefGoogle Scholar
  6. 6.
    Alvarez Marcos F, Llaneza Coto JM, Franco Meijide FJ, Zanabili Al-Sibbai AA, Vilarino Rico J, Alonso Perez M, et al. Effect of antiplatelet therapy on aneurysmal sac expansion associated with type II endoleaks after endovascular aneurysm repair. J Vasc Surg. 2017;66:396–403.CrossRefGoogle Scholar
  7. 7.
    Tsuyuki Y, Matsushita S, Dohi S, Yamamoto T, Tambara K, Inaba H, et al. Factors for sac size change of abdominal aortic aneurysm after endovascular repair. Ann Thorac Cardiovasc Surg. 2014;20:1016–20.CrossRefGoogle Scholar
  8. 8.
    Pini R, Faggioli G, Mascoli C, Gallitto E, Freyrie A, Gargiulo M, et al. Influence of statin therapy on type 2 endoleak evolution. Ann Vasc Surg. 2015;29:1167–73.CrossRefGoogle Scholar
  9. 9.
    Kaladji A, Cardon A, Abouliatim I, Campillo-Gimenez B, Heautot JF, Verhoye JP. Preoperative predictive factors of aneurysmal regression using the reporting standards for endovascular aortic aneurysm repair. J Vasc Surg. 2012;55:1287–95.CrossRefGoogle Scholar
  10. 10.
    Bailey MA, Sohrabi S, Flood K, Griffin KJ, Rashid ST, Johnson AB, et al. Calcium channel blockers enhance sac shrinkage after endovascular aneurysm repair. J Vasc Surg. 2012;55:1593–9.CrossRefGoogle Scholar
  11. 11.
    Munakata M, Konno S, Miura Y, Yoshinaga K. Prognostic significance of the brachial-ankle pulse wave velocity in patients with essential hypertension: final results of the J-TOPP study. Hypertens Res. 2012;35:839–42.CrossRefGoogle Scholar
  12. 12.
    Hori D, Akiyoshi K, Yuri K, Nishi S, Nonaka T, Yamamoto T, et al. Effect of endoskeleton stent graft design on pulse wave velocity in patients undergoing endovascular repair of the aortic arch. Gen Thorac Cardiovasc Surg. 2017;65:506–11.CrossRefGoogle Scholar
  13. 13.
    Cieri E, De Rango P, Isernia G, Simonte G, Verzini F, Parlani G, et al. Effect of stentgraft model on aneurysm shrinkage in 1450 endovascular aortic repairs. Eur J Vasc Endovasc Surg. 2013;46:192–200.CrossRefGoogle Scholar
  14. 14.
    Lalys F, Daoudal A, Gindre J, Goksu C, Lucas A, Kaladji A. Influencing factors of sac shrinkage after endovascular aneurysm repair. J Vasc Surg. 2017;65:1830–38.CrossRefGoogle Scholar
  15. 15.
    Chikazawa G, Hiraoka A, Totsugawa T, Tamura K, Ishida A, Sakaguchi T, et al. Influencing factors for abdominal aortic aneurysm sac shrinkage and enlargement after EVAR: clinical reviews before introduction of preoperative coil embolization. Ann Vasc Dis. 2014;7:280–5.CrossRefGoogle Scholar
  16. 16.
    Moulakakis KG, Mylonas SN, Kakisis J, Kadoglou NP, Papadakis I, Sfyroeras GS, et al. Arterial stiffness alterations and inflammatory response following endovascular aortic repair: based on a presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA). Aorta (Stamford, Conn) 2015;3:75–80.Google Scholar
  17. 17.
    Kwon ST, Rectenwald JE, Baek S. Intrasac pressure changes and vascular remodeling after endovascular repair of abdominal aortic aneurysms: review and biomechanical model simulation. J Biomech Eng. 2011;133:011011.  https://doi.org/10.1115/1.4003134.CrossRefPubMedGoogle Scholar
  18. 18.
    Yeung JJ, Hernandez-Boussard TM, Song TK, Dalman RL, Lee JT. Preoperative thrombus volume predicts sac regression after endovascular aneurysm repair. J Endovasc Ther. 2009;16:380–8.CrossRefGoogle Scholar
  19. 19.
    Vorp DA, Lee PC, Wang DH, Makaroun MS, Nemoto EM, Ogawa S, et al. Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and wall weakening. J Vasc Surg. 2001;34:291–9.CrossRefGoogle Scholar
  20. 20.
    Kazi M, Thyberg J, Religa P, Roy J, Eriksson P, Hedin U, et al. Influence of intraluminal thrombus on structural and cellular composition of abdominal aortic aneurysm wall. J Vasc Surg. 2003;38:1283–92.CrossRefGoogle Scholar
  21. 21.
    Georgakarakos E, Georgiadis GS, Ioannou CV, Kapoulas KC, Trellopoulos G, Lazarides M. Aneurysm sac shrinkage after endovascular treatment of the aorta: beyond sac pressure and endoleaks. Vasc Med. 2012;17:168–73.CrossRefGoogle Scholar
  22. 22.
    Janic M, Lunder M, Sabovic M. Arterial stiffness and cardiovascular therapy. Biomed Res Int. 2014;2014:621437.  https://doi.org/10.1155/2014/621437.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Dias NV, Ivancev K, Resch TA, Malina M, Sonesson B. Endoleaks after endovascular aneurysm repair lead to nonuniform intra-aneurysm sac pressure. J Vasc Surg. 2007;46:197–203.CrossRefGoogle Scholar
  24. 24.
    Dias NV, Ivancev K, Malina M, Resch T, Lindblad B, Sonesson B. Intra-aneurysm sac pressure measurements after endovascular aneurysm repair: differences between shrinking, unchanged, and expanding aneurysms with and without endoleaks. J Vasc Surg. 2004;39:1229–35.CrossRefGoogle Scholar
  25. 25.
    Dias NV, Ivancev K, Kolbel T, Resch T, Malina M, Sonesson B. Intra-aneurysm sac pressure in patients with unchanged AAA diameter after EVAR. Eur J Vasc Endovasc Surg. 2010;39:35–41.CrossRefGoogle Scholar
  26. 26.
    Hinnen JW, Koning OH, van Bockel JH, Hamming JF. Aneurysm sac pressure after EVAR: the role of endoleak. Eur J Vasc Endovasc Surg. 2007;34:432–41 (discussion 42–3).CrossRefGoogle Scholar
  27. 27.
    Phan DD, Meyer F, Pech M, Halloul Z. Length of abdominal aortic aneurysm and incidence of endoleaks type II after endovascular repair. Wien Klin Wochenschr. 2015;127:851–7.CrossRefGoogle Scholar
  28. 28.
    Gray C, Goodman P, Badger SA, O’Malley MK, O’Donohoe MK, McDonnell CO. Endovascular aneurysm repair increases aortic arterial stiffness when compared to open repair of abdominal aortic aneurysms. Vasc Endovasc Surg. 2016;50:317–20.CrossRefGoogle Scholar
  29. 29.
    Lantelme P, Dzudie A, Milon H, Bricca G, Legedz L, Chevalier JM, et al. Effect of abdominal aortic grafts on aortic stiffness and central hemodynamics. J Hypertens. 2009;27:1268–76.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Daijiro Hori
    • 1
    Email author
  • Yohei Nomura
    • 1
  • Taketo Yamauchi
    • 1
  • Hiroshi Furuhata
    • 1
  • Harunobu Matsumoto
    • 1
  • Naoyuki Kimura
    • 1
  • Koichi Yuri
    • 1
  • Atsushi Yamaguchi
    • 1
  1. 1.Department of Cardiovascular Surgery, Saitama Medical CenterJichi Medical UniversitySaitamaJapan

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