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European Radiology

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01-12-2019 | Aortic Aneurysm | Computed Tomography

New predictors of aneurysm sac behavior after endovascular aortic aneurysm repair

Authors: Min-Jae Jeong, Hyunwook Kwon, Gi-Young Ko, Dong Il Gwon, Min-Ju Kim, Youngjin Han, Tae-Won Kwon, Yong-Pil Cho

Published in: European Radiology | Issue 12/2019

Abstract

Objectives

This study aimed to identify new predictors of sac behavior after endovascular aortic aneurysm repair (EVAR) and to investigate whether sac behavior is associated with long-term clinical outcomes.

Methods

A total of 168 patients undergoing successful EVAR for abdominal aortic aneurysms with CTA follow-up of at least 1 year were included. Predictors of aneurysm sac behavior and its impact on long-term clinical outcomes were retrospectively analyzed.

Results

According to sac behavior, eligible patients were stratified into the sac regression group (n = 79, 47.0%) and the sac non-regression group (n = 89, 53.0%). Patients in the regression group were younger (p = 0.036) and more likely to take sarpogrelate hydrochloride postoperatively (p = 0.011) than those in the non-regression group. The incidence of postimplantation syndrome (PIS) was significantly higher in the regression group (p = 0.005). On multivariate analysis, sac regression was more likely to occur in those with PIS (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.07–2.64; p = 0.023) and less likely to occur in those with transient type II endoleaks (HR, 0.43; 95% CI, 0.20–0.95; p = 0.037) and higher thrombus density within the sac on follow-up CTA (HR, 0.97; 95% CI, 0.95–0.99; p = 0.013). Non-regression of the sac was associated with significantly higher rates of re-intervention during the follow-up period (p = 0.001).

Conclusions

In addition to type II endoleaks, PIS and thrombus density are new predictors of aneurysm sac behavior, and sac regression is significantly associated with lower rates of re-intervention.

Key Points

• After endovascular aortic aneurysm repair (EVAR), patients with sac regression were younger and more likely to take sarpogrelate hydrochloride postoperatively than those with sac non-regression.

• The incidence of postimplantation syndrome (PIS) was significantly higher in patients with sac regression.

• In our analysis, PIS and thrombus density within the sac were newly identified predictors of aneurysm sac behavior after EVAR.

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Blankensteijn JD, de Jong SE, Prinssen M et al (2005) Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 352:2398–2405CrossRef

Kim W, Gandhi RT, Peña CS et al (2017) Influence of statin therapy on aneurysm sac regression after endovascular aortic repair. J Vasc Interv Radiol 28:35–43CrossRef

Lee JT, Aziz IN, Lee JT et al (2003) Volume regression of abdominal aortic aneurysms and its relation to successful endoluminal exclusion. J Vasc Surg 38:1254–1263CrossRef

Deery SE, Ergul EA, Schermerhorn ML et al (2018) Aneurysm sac expansion is independently associated with late mortality in patients treated with endovascular aneurysm repair. J Vasc Surg 67:157–164CrossRef

Kaladji A, Cardon A, Abouliatim I, Campillo-Gimenez B, Heautot JF, Verhoye JP (2012) Preoperative predictive factors of aneurysmal regression using the reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 55:1287–1295CrossRef

Long A, Rouet L, Lindholt JS, Allaire E (2012) Measuring the maximum diameter of native abdominal aortic aneurysms: review and critical analysis. Eur J Vasc Endovasc Surg 43:515–524CrossRef

Chaikof EL, Blankensteijn JD, Harris PL et al (2002) Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 35:1048–1060CrossRef

Kwon H, Ko GY, Kim MJ et al (2016) Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm. Medicine (Baltimore) 95:e4532CrossRef

Kalender G, Lisy M, Stock UA, Endisch A, Kornberger A (2017) Identification of factors influencing cumulative long-term radiation exposure in patients undergoing EVAR. Int J Vasc Med 2017:9763075PubMedPubMedCentral

10.

Lo RC, Buck DB, Herrmann J et al (2016) Risk factors and consequences of persistent type II endoleaks. J Vasc Surg 63:895–901CrossRef

11.

Puig J, Pedraza S, Demchuk A et al (2012) Quantification of thrombus hounsfield units on noncontrast CT predicts stroke subtype and early recanalization after intravenous recombinant tissue plasminogen activator. AJNR Am J Neuroradiol 33:90–96CrossRef

12.

Arnaoutoglou E, Kouvelos G, Papa N et al (2016) Prospective evaluation of postimplantation syndrome evolution on patient outcomes after endovascular aneurysm repair for abdominal aortic aneurysm. J Vasc Surg 63:1248–1255CrossRef

13.

De Haro J, Acin F, Bleda S, Varela C, Medina FJ, Esparza L (2012) Prediction of asymptomatic abdominal aortic aneurysm expansion by means of rate of variation of C-reactive protein plasma levels. J Vasc Surg 56:45–52CrossRef

14.

Domanovits H, Schillinger M, Müllner M et al (2002) Acute phase reactants in patients with abdominal aortic aneurysm. Atherosclerosis 163:297–302CrossRef

15.

De Haro J, Bleda S, Acin F (2016) C-reactive protein predicts aortic aneurysmal disease progression after endovascular repair. Int J Cardiol 202:701–706CrossRef

16.

Marie PY, Plissonnier D, Bravetti S et al (2018) Low baseline and subsequent higher aortic abdominal aneurysm FDG uptake are associated with poor sac shrinkage post endovascular repair. Eur J Nucl Med Mol Imaging 45:549–557CrossRef

17.

Rai D, Wisniowski B, Bradshaw B et al (2014) Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair. Eur Radiol 24:1768–1776CrossRef

18.

Leurs LJ, Kievit J, Dagnelie PC, Nelemans PJ, Buth J, EUROSTAR Collaborators (2006) Influence of infrarenal neck length on outcome of endovascular abdominal aortic aneurysm repair. J Endovasc Ther 13:640–648CrossRef

19.

Castaigne P, Lhermitte F, Gautier JC, Escourolle R, Derouesné C (1970) Internal carotid artery occlusion: a study of 61 instances in 50 patients with post-mortem data. Brain 93:231–258CrossRef

20.

Mokin M, Morr S, Natarajan SK et al (2015) Thrombus density predicts successful recanalization with Solitaire stent retriever thrombectomy in acute ischemic stroke. J Neurointerv Surg 7:104–107CrossRef

21.

Hayashi T, Sumi D, Matsui-Hirai H et al (2003) Sarpogrelate HCl, a selective 5-HT2A antagonist, retards the progression of atherosclerosis through a novel mechanism. Atherosclerosis 168:23–31CrossRef

22.

Dinerman JL, Lowenstein CJ, Snyder SH (1993) Molecular mechanisms of nitric oxide regulation. Potential relevance to cardiovascular disease. Circ Res 73:217–222CrossRef

23.

Nosoudi N, Nahar-Gohad P, Sinha A et al (2015) Prevention of abdominal aortic aneurysm progression by targeted inhibition of matrix metalloproteinase activity with batimastat-loaded nanoparticles. Circ Res 117:e80–e89CrossRef

24.

Zhu C, Tian B, Leach JR et al (2017) Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography. Eur Radiol 27:1787–1794CrossRef

25.

Behr-Rasmussen C, Grondal N, Bramsen MB, Thomsen MD, Lindholt JS (2014) Mural thrombus and the progression of abdominal aortic aneurysms: a large population-based prospective cohort study. Eur J Vasc Endovasc Surg 48:301–307CrossRef

26.

Metaxa E, Kontopodis N, Tzirakis K, Ioannou CV, Papaharilaou Y (2015) Effect of intraluminal thrombus asymmetrical deposition on abdominal aortic aneurysm growth rate. J Endovasc Ther 22:406–412CrossRef

27.

Nchimi A, Courtois A, El Hachemi M et al (2016) Multimodality imaging assessment of the deleterious role of the intraluminal thrombus on the growth of abdominal aortic aneurysm in a rat model. Eur Radiol 26:2378–2386CrossRef

28.

Partovi S, Trischman T, Rafailidis V et al (2018) Multimodality imaging assessment of endoleaks post-endovascular aortic repair. Br J Radiol 91(1087):20180013. https://doi.org/10.1259/bjr.20180013 CrossRefPubMedPubMedCentral

29.

Motta R, Rubaltelli L, Vezzaro R et al (2012) Role of multidetector CT angiography and contrast-enhanced ultrasound in redefining follow-up protocols after endovascular abdominal aortic aneurysm repair. Radiol Med 117(6):1079–1092CrossRef

30.

Stavropoulos SW, Charagundla SR (2007) Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Radiology 243:641–655CrossRef

31.

Saba L, Montisci R, Sanfilippo R et al (2009) Imaging of the endoleak after endovascular aneurysm repair procedure by using multidetector computer tomography angiography. J Cardiovasc Surg (Torino) 50:515–526

32.

Iezzi R, Cotroneo AR, Filippone A et al (2006) Multidetector CT in abdominal aortic aneurysm treated with endovascular repair: are unhenanced and delayed phase enhanced images effective for endoleak detection? Radiology 241:915–921CrossRef

Title: New predictors of aneurysm sac behavior after endovascular aortic aneurysm repair
Authors: Min-Jae Jeong
Hyunwook Kwon
Gi-Young Ko
Dong Il Gwon
Min-Ju Kim
Youngjin Han
Tae-Won Kwon
Yong-Pil Cho
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Aortic Aneurysm
Aneurysm
Aortic Aneurysm
Aneurysm
Abdominal Aortic Aneurysm
Abdominal Aortic Aneurysm
Published in: European Radiology / Issue 12/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06306-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

New predictors of aneurysm sac behavior after endovascular aortic aneurysm repair

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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