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New predictors of aneurysm sac behavior after endovascular aortic aneurysm repair

European Radiology volume 29, pages 6591–6599 (2019)Cite this article

Abstract

Objectives

This study aimed to identify new predictors of sac behavior after endovascular aortic aneurysm repair (EVAR) and to investigate whether sac behavior is associated with long-term clinical outcomes.

Methods

A total of 168 patients undergoing successful EVAR for abdominal aortic aneurysms with CTA follow-up of at least 1 year were included. Predictors of aneurysm sac behavior and its impact on long-term clinical outcomes were retrospectively analyzed.

Results

According to sac behavior, eligible patients were stratified into the sac regression group (n = 79, 47.0%) and the sac non-regression group (n = 89, 53.0%). Patients in the regression group were younger (p = 0.036) and more likely to take sarpogrelate hydrochloride postoperatively (p = 0.011) than those in the non-regression group. The incidence of postimplantation syndrome (PIS) was significantly higher in the regression group (p = 0.005). On multivariate analysis, sac regression was more likely to occur in those with PIS (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.07–2.64; p = 0.023) and less likely to occur in those with transient type II endoleaks (HR, 0.43; 95% CI, 0.20–0.95; p = 0.037) and higher thrombus density within the sac on follow-up CTA (HR, 0.97; 95% CI, 0.95–0.99; p = 0.013). Non-regression of the sac was associated with significantly higher rates of re-intervention during the follow-up period (p = 0.001).

Conclusions

In addition to type II endoleaks, PIS and thrombus density are new predictors of aneurysm sac behavior, and sac regression is significantly associated with lower rates of re-intervention.

Key Points

• After endovascular aortic aneurysm repair (EVAR), patients with sac regression were younger and more likely to take sarpogrelate hydrochloride postoperatively than those with sac non-regression.

• The incidence of postimplantation syndrome (PIS) was significantly higher in patients with sac regression.

• In our analysis, PIS and thrombus density within the sac were newly identified predictors of aneurysm sac behavior after EVAR.

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Fig. 1

Abbreviations

AAA:

Abdominal aortic aneurysm

CI:

Confidence interval

CRP:

C-reactive protein

DUS:

Duplex ultrasound

EVAR:

Endovascular aortic aneurysm repair

HR:

Hazard ratio

HU:

Hounsfield unit

PIS:

Postimplantation syndrome

WBC:

White blood cell

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Funding

The authors state that this work has not received any funding.

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Affiliations

  1. Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505, Republic of Korea

    Min-Jae Jeong, Hyunwook Kwon, Youngjin Han, Tae-Won Kwon & Yong-Pil Cho

  2. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Gi-Young Ko & Dong Il Gwon

  3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Min-Ju Kim

Authors
  1. Min-Jae Jeong
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  2. Hyunwook Kwon
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  4. Dong Il Gwon
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  5. Min-Ju Kim
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Correspondence to Yong-Pil Cho.

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Guarantor

The scientific guarantor of this study is Yong-Pil Cho.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Min-Ju Kim) has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained (2018–0288).

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• observational

• performed at one institution

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Jeong, MJ., Kwon, H., Ko, GY. et al. New predictors of aneurysm sac behavior after endovascular aortic aneurysm repair. Eur Radiol 29, 6591–6599 (2019). https://doi.org/10.1007/s00330-019-06306-5

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  • DOI: https://doi.org/10.1007/s00330-019-06306-5

Keywords

  • Aortic aneurysm, abdominal
  • Endovascular procedures
  • Treatment outcomes