Virendra I. Patel1, Emel Ergul1, Mark F. Conrad1, Edwin Gravereaux2, Marc L. Schermerhorn2, Andres Schanzer2, Philip P. Goodney2, Richard P. Cambria1
1Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA; 2Vascular Study Group of New England, Lebanon, NH.
OBJECTIVES: Patients undergoing EVAR of AAA can exhibit variations in sac behavior from complete regression to expansion. We evaluated the impact of sac behavior at one year follow-up on late survival.
METHODS: We used the Vascular Study Group of New England (VSGNE) registry (2003-2011) to identify EVAR patients with one year CT follow up. Aneurysm sac enlargement >5mmm (SacEn) or decrease >5mm (SacDe) was defined according to SVS guidelines, and predictors of change in sac size and impact of sac behavior were assessed by multivariable methods.
RESULTS: 1,642 EVAR patients with 1 year follow-up were included. At 1 year, 8% had SacIn, 72% had SacDe and 20% had stable sac size. Independent predictors of SacIn were urgent repair (OR2.9 [95%CI:1.7-5.0]; p<0.01), intraoperative type I/III endoleak (OR2.7 [95%CI:1.1-6.9]; p=0.03), hypogastric coverage (OR2.2 [95%CI:1.3-3.9]; p<0.01), and any type II endoleak (OR1.7 [95%CI:1.1-2.6]; p<0.01). SacDe was more likely to occur in smokers (OR1.7 [95%CI:1.2-2.4]; p<0.01), and less likely to occur in patients who had iliac aneurysm repair (OR0.7 [95%CI:0.5-0.95];p=0.02), and any re-intervention (OR0.6 [95%CI:0.4-0.9]; p=0.03). Risk adjusted (age, symptoms/rupture, re-intervention, hypogastric coverage, low EF, smoking) Cox regression showed that SacIn independently predicted increase in late mortality (HR2.2 [95%CI:1.4-3.7]; p<0.01), while SacDe had no impact (HR0.9 [95%CI:0.6-1.3]; p=0.5). Long-term survival was lower (Log rank p<0.01) in patients with SacIn (94±2% 1year and 57±6% 5 year.) compared to all others (99±1% 1 year and 81±2% 5 year).
CONCLUSIONS: These data suggest that AAA sac size increase greater than 5mm at one year, albeit infrequent is an independent predictor of late mortality and warrants close observation and early intervention.
AUTHOR DISCLOSURES: R. P. Cambria: Nothing to disclose; M. F. Conrad: Nothing to disclose; E. Ergul: Nothing to disclose; P. P. Goodney: Nothing to disclose; E. Gravereaux: Nothing to disclose; V. I. Patel: Nothing to disclose; A. Schanzer: Nothing to disclose; M. L. Schermerhorn: Nothing to disclose.
Posted April 2013