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 SS12. What is the Fate of Untreated Concomitant Suprarenal Aortic Aneurysms Following EVAR?

​Benjamin J. Herdrich, Erin M. Murphy, Grace J. Wang, Benjamin M. Jackson, Ronald M. Fairman, Edward Y. Woo
The University of Pennsylvania School of Medicine, Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Philadelphia, PA.

OBJECTIVES: There are many patients treated with EVAR who have a concomitant aneurysm of the suprarenal aorta (sAAA). The natural history of these sAAAs and whether they affect the results of EVAR are unknown.

METHODS: Four-hundred seventy patients in the M2S database were identified as having an infrarenal abdominal aortic aneurysm (iAAA) with a concomitant sAAA (diameter 2.9-4.7cm). Patients with a preoperative CTA and follow-up imaging =12 months (n=239) were included in the analysis. Patients who did not undergo EVAR served as a control(C) (n=81). Patients with EVAR were subdivided into suprarenal fixation (SR)(n=94) and infrarenal fixation (IR) (n=64). Standard measurements from the M2S images were extracted, and growth rates were calculated for different abdominal aortic segments.

RESULTS: The average follow-up was 32.1±19.8 months. The average initial size and growth rate of the sAAA was 34.50±3.31mm and 0.56±1.35mm/yr for patients undergoing EVAR (SR+IR) compared with 36.68±3.67 mm (p<0.05) and 0.60±2.87mm/yr (p=0.17) for controls. Following EVAR, 1.3% of patients (SR-1/94=1.1%; IR 1/64=1.6%) experienced sAAA growth to a diameter =50 mm which was not significantly different from the control group (4/81=4.9%,p=0.09) and occurred at a mean of 43.5 months (range 9.8-59.4). Comparing the SR and IR groups, there was no difference in the preoperative sAAA diameter (SR 34.66±3.09mm, IR 34.26±3.61, p=0.75). Postoperative sAAA growth rate (SR 0.56±1.20mm/yr, IR 0.55±1.55, p=0.98), aortic growth rate at the renals (SR 1.00±1.81mm/yr, IR 0.90±1.50,p=0.69), iAAA growth rate (SR -1.68±5.79 mm/yr, IR -1.38±5.09, p=0.73), and iAAA change in volume (SR -10.58±34.65 mL/yr, IR -6.11±29.14, p=0.40) were also not significantly different.

CONCLUSIONS: Isolated treatment of iAAA via EVAR with a concomitant sAAA is acceptable as the endograft (suprarenal or infrarenal) does not affect growth rates of the sAAA. Standard EVAR follow-up is all that is required as only a small minority demonstrate growth.

AUTHOR DISCLOSURES: R. M. Fairman, Nothing to disclose; B. J. Herdrich, Nothing to disclose; B. M. Jackson, Nothing to disclose; E. M. Murphy, Nothing to disclose; G. J. Wang, Nothing to disclose; E. Y. Woo, M2S,Consulting fees or other remuneration (payment).

Posted April 2012

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