ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2020 June;61(3):317-22

DOI: 10.23736/S0021-9509.18.10584-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Post-EVAR aneurysm sac shrinkage is prognostically favorable, but does not justify withholding follow-up

Jasper C. LANGENBERG ¹ ✉, Joost ROIJERS ¹, Gwan H. HO ¹, Eelco J. VEEN ¹, Douwe VOS ², Thijs BUIMER ¹, Hans G. DE GROOT ¹, Lyckle van der LAAN ¹

¹ Department of Surgery, Amphia Hospital, Breda, the Netherlands; ² Department of Radiology, Amphia Hospital, Breda, the Netherlands

BACKGROUND: One of the main drawbacks of endovascular aortic aneurysm repair (EVAR) compared to open aortic surgery is the possibility of developing endoleaks and secondary aneurysm rupture, requiring frequent imaging follow-up. This study aims to identify prognostic factors that could be incorporated in follow-up protocols, which might lead to better personalized, lower cost and safe EVAR follow-up.
METHODS: A retrospective study was performed including all patients who underwent elective EVAR from January 2000 to December 2015. Follow-up data were gathered by reviewing medical files for radiographic imaging. Linear and logistic regressions were used to assess predictive factors for aneurysm shrinkage.
RESULTS: In 361 patients, aneurysm sac shrinkage of 10 mm or more was measured in 152 (42.1%) patients. Patients with ≥10-mm aneurysm shrinkage had fewer endoleaks (4.3% vs. 24.6%, P<0.0001) and fewer re-interventions for endoleak (3.0% vs. 10.1%, P=0.007). Aneurysm sac shrinkage was correlated with the absence of endoleak development (OR 0.36, 95% CI 0.19-0.66, P=0.001). In patients who had achieved ≥10-mm shrinkage of the aneurysm sac, no further significant growth was seen, compared to 38 (15.3%) patients who did not attain size reduction (P<0.001).
CONCLUSIONS: Once patients achieve ≥10-mm aneurysm sac shrinkage, they are less prone to developing subsequent aneurysm growth and have significantly lower risk of requiring surgery for endoleaks. However, a small number of patients remain at risk of requiring endoleak surgery after aneurysm shrinkage. Therefore, we would not recommend ceasing life-long imaging follow-up after significant aneurysm sac shrinkage, though it might be safe to increase the interval of follow-up.

KEY WORDS: Endovascular procedures; Endoleaks; Aortic aneurysm