Aortic necks of ruptured abdominal aneurysms dilate more than asymptomatic aneurysms after endovascular repair

Endovascular repair of abdominal aortic aneurysm (AAA) is increasingly used. We evaluated if a difference exists in the rate of change of the aortic neck diameter between non-ruptured and ruptured AAAs after endovascular aneurysm repair (EVAR). Details of patients undergoing elective (group I) and e...

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Bibliographic Details
Published in:Journal of vascular surgery 2006-08, Vol.44 (2), p.244-249
Main Authors: Badger, Stephen A., O’Donnell, Mark E., Makar, Ragai R., Loan, William, Lee, Bernard, Soong, Chee V.
Format: Article
Language:English
Subjects:
Aged
Angioplasty - methods
Aortic Aneurysm, Abdominal - diagnostic imaging
Aortic Aneurysm, Abdominal - surgery
Aortic Aneurysm, Abdominal - therapy
Aortic Rupture - diagnostic imaging
Aortic Rupture - surgery
Aortic Rupture - therapy
Aortography
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Diseases of the aorta
Female
Humans
Male
Medical Records Systems, Computerized
Medical sciences
Prosthesis Failure
Retrospective Studies
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Stents
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tomography, Spiral Computed
Treatment Outcome
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Endovascular repair of abdominal aortic aneurysm (AAA) is increasingly used. We evaluated if a difference exists in the rate of change of the aortic neck diameter between non-ruptured and ruptured AAAs after endovascular aneurysm repair (EVAR). Details of patients undergoing elective (group I) and emergency (group II) EVAR using Talent stents between October 1999 and September 2005 were reviewed. Top neck diameters were prospectively recorded on the hospital database from computed tomography scans preoperatively and at 1, 3, 12, and 24 months postoperatively. The aortic neck diameter rate of change was calculated for each group. Endovascular repair was performed on 110 elective and 41 emergency patients, of which 100 (80 male) elective and 29 (26 male) emergency patients were included in this analysis. Mean age was similar in each group. Stents were oversized by 20.9% ± 13.6% in group I and by 24.7% ± 16.3% in group II ( P = .37). The preoperative mean proximal aortic neck was larger in group II (25.0 ± 3.3 mm vs 23.5 ± 2.8 mm; P = .029). The growth rate of the top neck diameter was significantly greater at 12 months (1.48 ± 2.4 mm/year vs 3.89 ± 6.24 mm/year; P = .04) and 24 months (.99 ± 1.1 mm/year vs 2.61 ± 3.3 mm/year; P = .04) in group II than in group I. A decreasing sac size was found in 68.2% of patients whose neck dilated. The complication rate was similar in each group. Aneurysm necks in patients with ruptured aneurysms are larger and dilate at a greater rate than those with nonruptured aneurysms. The accelerated rate of expansion in some patients must be borne in mind during follow-up and in secondary endovascular interventions and conversion to open surgery.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2006.03.042