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Home > Vascular Annual Meeting^® > PVSS8. Surveillance of EVAR Using Wireless Intrasac...

PVSS8. Surveillance of EVAR Using Wireless Intrasac Pressure Monitoring Device

Hemal J. Shah, MD; Amit R. Shah, MD; William D. Suggs, MD;  Nicholas Gargiulo, MD; Larry Scher, MD; Takao Ohki, MD; Evan C. Lipsitz, MD
Montefiore Medical Center, Bronx, NY

OBJECTIVES: To review our experience with wireless intrasac pressure monitoring during post-EVAR surveillance.

METHODS: A total of sixty EVAR patients were implanted with a CardioMEMS Endosure® sensor since 2004. Sac and systemic pressures were measured prior to aneurysm exclusion, post-exclusion, and at follow-up for up to 3 years. A set of pressure indices, systolic (SPI), diastolic (DPI), pulse (PPI), and mean (MPI), were used as ratios of sac to systemic pressures. CT and/or Duplex ultrasound were utilized for surveillance period. Pressure indices were compared according to t-test.

RESULTS: Sixty of sixty-one patients (98%) had successful implantation of the sensor. Mean follow-up was 17 months (range 1-42 months). A progressive decrease in all pressure indices correlated with successful sac exclusion and was observed across all follow-up periods until 24 months (p<0.01) after which time intrasac pressure remained low. A correlation between decreasing sac size and diminishing sac pressure was observed. Five Type II endoleaks (3 noted intraoperatively, 2 on follow-up) were discovered. In these five patients pressure indices also decreased, but not to a significant degree. Four endoleaks resolved spontaneously with continued decreasing sac pressures and one was lost to follow-up. One Type III endoleak was discovered during surveillance with increase in MPI & PPI to 1. After repair, sac pressure decreased indicating successful treatment, which was confirmed by CTA.

CONCLUSIONS: Intrasac pressure as assessed by wireless sensor monitoring decreases with successful aneurysm exclusion and continues to decrease with time. In a small subset of patients with a Type II endoleak, intrasac pressures also decreased, however to a lesser degree. The ultimate role of wireless pressure sensor monitoring post-EVAR remains to be determined, but our results and those of others suggest some clinical utility.

AUTHOR DISCLOSURES: H.J. Shah, None; A.R. Shah, None; W.D. Suggs, Cardiomems; N. Gargiulo, Cardiomems; L. Scher, Cardiomems; T. Ohki, Cardiomems;  E.C. Lipsitz, Cardiomems.

Figure 1.