Vaskulárna medicína 2-3/2018
The impact of type II endoleak on aneurysm sac dynamics after endovascular abdominal aortic aneurysm repair
Background: Optimal treatment result after endovascular abdominal aortic aneurysm repair (EVAR) is following with significant aneurysm sac regression without endoleak. The aim of our study was to evaluate diameter of abdominal aneurym sac 24 months after EVAR, to evaluate association of persistent type II endoleak with sac dynamics and to compare all–cause mortality between patients with/without sac regression during long–term follow–up. Methods: We retrospectively analyzed data of patients with infrarenal abdominal aortic aneurysm (AAA) treated between January, 2010 and July, 2016. The initial sac diameter and diameter 24 months after EVAR was determined by CT– angiography at the site of maximum axial diameter. Sac expansion was defined as at least 5 mm increase, sac regression as at least 5 mm decrease in sac diameter relative to the preprocedural diameter. AAA sac changes between – 5 mm and + 5 mm were defined as stable sac. Results: During the study period, 124 patients (116 men and 8 women) with mean age 71.2 ± 7.2 years were evaluated. Sac regression was found in 45.2% of patients, stable sac in 46.0% of patients and sac expansion in 8.9% of patients. Perzistent type II endoleak was inversely associated with sac regression (vs stable sac and sac expansion) in univariate analysis and multivariate analysis after adjustment of smoking, sex, hypertension and dyslipidaemia (OR 0.28; 95% CI 0.11–0.70; p=0.006). Risk of sac expansion (vs stable sac and sac regression) was 4.3–times higher in the presence of type II endoleak in multivariable analysis (OR 4.33; 95%CI 1.07–17.7; p=0.041). During long–term follow–up, no difference was found between patient subgroups with sac regression and without it in all–cause mortality (HR 1,19; 95%CI 0,58–2,44; p=0,634). Conclusion: Aneurysm sac regression after EVAR was inversely associated with the presence of persistent type II endoleak. Persistent type II endoleak increased risk of sac expansion. No difference was found in long–term survival between groups of patients with sac regression and without it.
Keywords: endovascular abdominal aortic aneurysm repair, abdominal aortic aneurysm, endoleak, fibrinogen, sac regression, sac expansion
