Significant sac retraction after endovascular aneurysm repair is a robust indicator of durable treatment success

• Published in: Journal of vascular surgery 2010-10, Vol.52 (4), p.878-883
• Main Authors: Houbballah, Rabih, MD, Majewski, Marek, MD, Becquemin, Jean-Pierre, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Cardiology. Vascular system; Diseases of the aorta; France; Humans; Kaplan-Meier Estimate; Logistic Models; Medical sciences; Middle Aged; Odds Ratio; Predictive Value of Tests; Proportional Hazards Models; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2010.04.069

Objectives The principal aim of this study was to demonstrate that significant sac retraction (SSR) was a predictive marker of durable success after endovascular aortic repair (EVAR). If verified, follow-up (FU) of patients with SSR may become unnecessary. In addition, the clinical features of the patients and aneurysms were analyzed to identify predictive factors of SSR. Methods A group of 371 patients treated by EVAR had a complete clinical exam, computed tomography (CT) scan, and duplex scan follow-up. Data were collected prospectively and analyzed retrospectively. We assessed the difference between the largest diameter of the aneurysm (D) and the diameter of the stent-graft body (D1) on each postoperative CT scan. SSR was defined as a minimum of 75% reduction of this difference between the first and any of the following CT scans. Treatment success was defined as survival free of aneurysm-related death, type I or III endoleak, aneurysm expansion exceeding 5 mm, rupture, surgical conversion, migration, and graft occlusion. To assess the predictive factors of SSR, we performed a multivariable analysis and a logistic regression of the most significant variables. Results SSR was observed in 24.8% (92/371) of the patients after an average of 26 ± 21 months of FU. The mean duration of FU in this group was 50 ± 26 months (vs 45 ± 25 months; P = NS). Survival was significantly longer in the SSR group (96 ± 3 months vs 93 ± 3 months; P < .05). No rupture, surgical, or endovascular conversion was reported in the SSR group. The frequency of type I (2.2% vs 15.4%; P < .001), type II (3.3% vs 29.4%; P < 10-6 ), and secondary interventions (3.3% vs 13.3%; P < .05) was lower in the SSR group. All type I and III endoleaks were diagnosed and treated before SSR detection. Since SSR was detected, treatment success remained until last follow-up in 98.9% (91 of 92) of the patients. The independent predictive factors of SSR were abdominal aortic aneurysm (AAA) diameter