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PVSS12. Device Specific Aneurysm Sac Morphology Following EVAR: Evaluation Of Contemporary Graft Materials

Harshal Broker, Kosta Foteh, Erin H. Murphy, G. Patrick Clagett, R. James Valentine, Carlos H. Timaran, J. Gregory Modrall, Frank R. Arko.
UT Southwestern Medical Center , Dallas, Texas.

OBJECTIVES: To analyze device specific aneurysm sac morphology following EVAR with low permeability devices.

METHODS: Between September 2004 to May 2006 122 patients were treated with EVAR. Three different devices were implanted: 47 Zenith (Cook, Indianapolis, IN), 46 AneuRx (Medtronic, Santa Rosa, CA) with Resiliant Graft Material, and 29 Excluder (Gore, Flagstaff, AZ) with low porosity PTFE. Patients were followed at 1, 3, 6, 12 month intervals with CTA. Standard axial two dimensional computerized tomography measurements were obtained and compared with preoperative imaging. The preoperative scan served as a baseline, and the minor axis diameter, measured at the largest axial cut of the abdominal aortic aneurysm, was compared with the same measurement at follow up.

RESULTS:  Patient age, sex, and mean maximum aneurysm diameter at baseline were similar among groups. The rate of Type II endoleak were similar for the Zenith (17%), AneuRx (17%), and Excluder (14%). Sac shrinkage at 1 month was 3.9%, 8.9%, and 1.2% for the Zenith, AneuRx, and Excluder (p<0.05). At 6 months there was a 2.4%, 11.4%, and a 1.0% sac shrinkage for the Zenith, AneuRx, and Excluder, respectively (p<0.05). At 12 months sac shrinkage was 11.9%, 18.4%, and 5.7% for Zenith, AneuRx, and Excluder, respectively (p<0.05). At 1 year, sac morphology decreased by 10.4 mm with the AneuRx, 6.73 mm with Zenith and 3.42 mm with the excluder (p<0.05). For patients with a Type II endoleak (n=19) there was a 8.06% decrease in sac size when compared to a 15.43% decrease in sac size in patients without endoleak (n=103) (p<0.05). No significant sac expansion was observed among any of the groups.

CONCLUSIONS: The introduction of new generation graft materials appears to favorably influence sac regression with all devices and are improved compared to published reports of older generation graft materials of the AneuRx and Excluder. However, there is a trend toward greater sac regression with devices utilizing Dacron over PTFE. The relationship of aneurysm morphology and long term effects on aortic stent grafts is yet to be determined.