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 RR19. Remodeling of Aortic Aneurysm and Aortic neck on Mid- and Long-term Follow-up After Endovascular Repair with Suprarenal Fixation

​Nikolaos Tsilimparis, Anand Dayama, Joseph J. Ricotta
Department of Surgery, Division of Vascular Surgery, Emory University School of Medicine, Atlanta, GA.

OBJECTIVES: To evaluate remodeling of the aortic neck, iliac arteries and aneurysm sac during follow-up after endovascular aortic aneurysm repair (EVAR) with the Zenith® AAA device.

METHODS: Retrospective study of anatomic data related to characteristics of the aortic neck, iliac arteries and aneurysm sac collected during a pivotal clinical study of the Zenith device. One-hundred fifty-eight patients were followed for 5 years.

RESULTS: Changes in aortic neck diameter below the renal arteries, aortic aneurysm sac diameter and iliac arteries diameter at distal attachment site for up to 5 years are shown in the Table.
Multivariate analysis of all anatomic aortic aneurysm characteristics for re-intervention identified only the angle between the immediate suprarenal neck and immediate infrarenal neck as an independent risk factor for re-intervention with an Odds ratio of 1.031 (CI 95%: 1.001-1.062). The mean value of the angle was 10.1±12°.

CONCLUSIONS: Expansion of the aortic neck post EVAR occurs mainly between 24-36 months while aortic aneurysm sac regression occurs more obviously at 1-12 months. Iliac arteries at the landing zone expand more rapidly in the first postoperative year. Long-term surveillance of EVAR-patients is essential to avoid late complications after aortic remodeling.

AUTHOR DISCLOSURES: A. Dayama, Nothing to disclose; J. J. Ricotta, Medtronic, Consulting fees or other remuneration (payment), Cook Medical, Consulting fees or other remuneration (payment); N. Tsilimparis, Nothing to disclose.

 

Table: Analysis of aneurysm remodeling over time (Mean±SD)

PRE
POST
30-day
6 Months
12 Months
24 Months
3 Years
4 Years
5 Years
Neck diameter (mm)
23.6 (±0.3)
27.8 (±0.3)
28.3 (±0.3)
28.8 (±0.3)
28.9 (±0.3)
29.1 (±0.3)
30.3 (±0.3)
30.7 (±0.3)
31.0 (±0.3)
Change to previous measurement
*4.3 (±0.2)
0.5 (±0.2)
0.5 (±0.2)
0.1 (±0.2)
0.3 (±0.2)
*1.1 (±0.3)
0.4 (±0.3)
0.3 (±0.3)
Aneurysm sac diameter (mm)
54.2 (±0.7)
57.2 (±0.7)
57.3 (±0.7)
52.4 (±0.7)
49.6 (±0.7)
47.0 (±0.7)
48.0 (±0.8)
47.1 (±0.7)
46.8 (±0.8)
Change to previous measurement
*3.0 (±0.6)
0.1 (±0.6)
*-4.9 (±0.6)
* -2.8 (±0.6)
*-2.6 (±0.6)
1.0 (±0.7)
-0.9 (±0.8)
-0.2 (±0.7)
Iliac - right (mm)
14.4 (±0.3)
16.3 (±0.3)
17.0 (±0.3)
17.8 (±0.3)
17.9 (±0.3)
18.0 (±0.3)
18.3 (±0.3)
18.4 (±0.3)
18.7 (±0.3)
Change to previous measurement
*1.9 (±0.2)
0.7 (±0.2)
0.8 (±0.2)
0.05 (±0.2)
0.1 (±0.2)
0.3 (±0.3)
0.1 (±0.3)
0.3 (±0.3)
Iliac - left (mm)
14.5 (±0.2)
15.8 (±0.2)
16.7 (±0.2)
17.6 (±0.2)
17.8 (±0.2)
18.0 (±0.2)
18.5 (±0.3)
18.6 (±0.2)
18.9 (±0.3)
Change to previous measurement
*1.4 (±0.2)
*0.8 (±0.2)
0.9 (±0.2)
0.1 (±0.2)
0.2 (±0.2)
0.6 (±0.2)
0.04 (±0.2)
0.4 (±0.2)
Changes 30-day-12-month: neck diameter 0.6 (±0.2), Aneurysm sac diameter: *-7.7(±0.6), iliac right: *0.9(±0.2), iliac left: *1.1(±0.2) *indicates p<0.0001

 

Posted April 2012

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