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Home > Vascular Annual Meeting > qin_early_postoperative

Early Postoperative Surveillance of EVAR and Endoleak Prediction Using Intrasac Pressure Monitoring

Feng Qin, Luis Davila-Santini, Rajeev Dayal, Ravi Pulipati, Richard Schultzer, Kambhampaty Krishnasastry.
North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, N.Y.

OBJECTIVES: To explore the utility of intrasac pressure monitoring for EVAR surveillance and its utility for endoleak prediction.

METHODS: 70 consecutive EVAR had concurrent CardioMEMS Endosure® implantation in 2007. Sac pressure was measured prior to aneurysm exclusion, post-exclusion, and follow-up to 12 months. To eliminate blood pressure variation, pressure indexes were created as ratios of sac pressures to systemic pressures as follows: systolic (SPI), diastolic (DPI), mean (MPI) and pulse (PPI) pressure index. CT scans were obtained at 1, 6 and 12 months, or anytime an endoleak was suspected

RESULTS: Technical success of endosure implantation was 98% (69/70). No perioperative mortality occurred. Mean follow-up was 6 months (range 1-12 months). 1) In patients without endoleak, a consistent pattern of sac pressure change, independent of individual systemic pressure variation, was observed during EVAR and follow-up. DPI elevation, SPI and PPI drop signaled successful sac exclusion. Sac pressures decreased continually in next 2 weeks and remain plateau (MPI <0.6, PPI <0.3) (p<.01) for up to 12 months [Figure 1]. 2) Follow-up CTA demonstrated a linear correlation between diminishing sac pressure and diminishing sac size (Pearson's coefficient, r=0.87) [Figure 2], and this correlation was independent of original aneurysmal size. 3.) Five type I endoleaks (3 intraoperatively, 2 follow-up) were discovered by sac pressure equivalent to systemic pressure (MPI ≈ 1), and pulsatile waveform with PPI >0.6 (p<.01) [Figure 3]. All were confirmed by angiogram (intra-op) or CTA and were treated successfully with extension cuffs. 4.) Twelve type II endoleaks/endotensions were suspected with variant MPI elevation (>0.6) but moderate PPI elevation (<0.6) (p<.01) [Figure 4] [Table 1]. CTA confirmed 10 of 12 cases as type II arising from the IMA or lumbar arteries. The remaining 2 cases were endotension. They resolved spontaneously or by coil.

CONCLUSIONS: A consistent pattern of sac pressure evolution after EVAR exists. Diminished sac pressure correlates to regressing sac size. The presence and type of endoleak can be predicted based on the character of sac pressure elevation. Long-term study is required to examine its potential to replace CTA for EVAR, but early surveillance appears enhanced with this modality.

AUTHOR DISCLOSURES: F. Qin, None; L. Davila-Santini, None; R. Dayal, W.L. Gore & Assoc; R. Pulipati, None; R. Schultzer, None; K. Krishnasastry, None.