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Home > Vascular Annual Meeting^® > RR9. Mid-term Postoperative Surveillance of EVAR...

RR9. Mid-term Postoperative Surveillance of EVAR and Endoleak Prediction Using Sac Pressure and Volume Monitoring

FENG QIN1, Rajeev Dayal1, Justin Rafael1, Luis Davila-Santini1, Julio Calderin1, Lorena DeMarco-Garcia1, Nicole Johnson2, Richard Schultzer1, Mihai Rosca1, Mark Kissin1, John Chang1, Omid Rahmani1, Toufic K. Safa1, William Purtill1, Mark Gennarro1, Kambhampaty Krishnasastry1
1North Shore-LIJ Healthcare System, Lake success, NY; 2Albert Einstein College of Medicine, Bronx, NY

OBJECTIVES: To evaluate the utility of aneurysm sac pressure and aneurysm volume monitoring for EVAR surveillance.

METHODS: 178 consecutive EVARs had concurrent CardioMEMS EndoSure® implantation during Jan. 2007-Dec. 2008. Post-operative intrasac pressure was measured at every office visit. Ratios of sac to systemic pressures were recorded as mean (MPI) and pulse (PPI) pressure indexes. CT scans were obtained at every 6 months or anytime an endoleak was suspected. Aneurysm sac volume was quantitated after constructed by volume rendering of CTA.

RESULTS: Technical success of EndoSure implantation was 98% (175/178). No sensor malfunctioned after successful implantation. Mean follow-up was 12.5 months (range 1-24 months). In EVAR without endoleak (143/175), sac pressure decreased progressively and remained plateaued (MPI<0.5, PPI<0.5) for 24 months. There was a strong correlation (r=0.87) between diminishing sac pressure and shrinking sac size. Thirty-two endoleaks developed (18.5%). Five type I endoleaks (3%) were discovered by sac pressure elevation (MPI>0.5) and pulsatile waveform (PPI>0.5) (Positive Predictive Value 100%). Twenty-seven type II endoleaks or endotensions (15.5%) were suspected with variant MPI elevation (>0.5) but normal PPI (<0.5)(PPV 100%). Endoleaks with markedly elevated sac pressure (MPI>1.0) were followed by sac volume expansion.

CONCLUSIONS: EVAR can be surveillanced safely by sac pressure monitoring up to 2 years. The type of endoleak can be predicted based on the character of sac pressure elevation. Suspected endoleak should be further examined by CTA with sac volume quantitation. Consistent sac pressure elevation with sac volume expansion warrants aggressive intervention.

AUTHOR DISCLOSURES: F. Qin, None; R. Dayal, None; J. Rafael, None; L. Davila-Santini, None; J. Calderin, None; L. DeMarco-Garcia, None; N. Johnson, None; R. Schultzer, None; M. Rosca, None; M. Kissin, None; J. Chang, None; O. Rahmani, None; T. Safa, None; W. Purtill, None; M. Gennarro, None; K. Krishnasastry, None.

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