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