Document Detail


Does sac size matter? Findings based on surgical exploration of excluded abdominal aortic aneurysms.
MedLine Citation:
PMID:  15823064     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To prospectively examine the outcomes of excluded abdominal aortic aneurysms (AAA) that continue to expand without evidence of endoleak. METHODS: From 1984 to 1998, 1218 patients underwent operative retroperitoneal exclusion of AAA and aortoiliac reconstructions. During the procedure, the aneurysm sac was ligated proximally, as well as distally, which created an ideal in-vivo model of excluded AAA sacs with or without endoleaks. From January 2002 to June 2003, 15 of these patients were identified as having an increase in AAA sac size with or without an endoleak on duplex ultrasonography. These patients were prospectively evaluated by computed tomography and diagnostic arteriography. Patients with a demonstrable endoleak underwent embolization, and the remainder underwent open surgical exploration. RESULTS: Eight patients had arteriographically demonstrated endoleaks that were treated with coil embolization. The remaining 7 patients (6 men; mean age 76 years, range 68-81) without a demonstrable endoleak underwent elective surgical exploration and sac endoaneurysmorrhaphy. The mean time interval between the original surgery and aneurysm sac exploration was 76 months (range 52-92); during this time, the mean aneurysm sac size increased by 2.7 cm (range 1.3-5.2). The mean sac pressure was 53 mmHg, and the sac walls were noticeably thickened, with markedly dilated vasa vasorum. The sac contained yellow, fibrinous material with clear serous fluid (5 patients without any evidence of retrograde flow) or liquefied thrombus with serosanguinous fluid (2 patients with retrograde flow from lumbar arteries). No AAA sacs were pulsatile. CONCLUSIONS: Continued expansion of excluded AAA sacs can occur from causes other than a missed endoleak. Exudation of fluid from thickened sac wall and vasa vasorum, as well as local enzymatic activity, might lead to the formation of a sac hygroma. Furthermore, these findings raise questions as to the need for surgical exploration of all patients with an enlarging AAA sac in the setting of low sac pressures and no definable endoleak.
Authors:
Manish Mehta; R Clement Darling; Benjamin B Chang; Philip S K Paty; Sean P Roddy; Paul B Kreienberg; Kathleen J Ozsvath; Dhiraj M Shah
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  12     ISSN:  1526-6028     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-04-12     Completed Date:  2005-09-29     Revised Date:  2007-05-23    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  183-8     Citation Subset:  IM    
Affiliation:
The Institute for Vascular Health and Disease, The Vascular Group PLLC, Albany, New York, USA. mehtam@albanyvascular.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty*
Aortic Aneurysm, Abdominal / pathology*,  radiography,  surgery*
Female
Follow-Up Studies
Humans
Iliac Artery / surgery
Male
Middle Aged
Prospective Studies
Recurrence
Retroperitoneal Space / surgery
Stents*
Treatment Failure
Comments/Corrections
Comment In:
Perspect Vasc Surg Endovasc Ther. 2005 Dec;17(4):382-4   [PMID:  16389441 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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