Document Detail


Variable sac behavior after endovascular repair of abdominal aortic aneurysm: analysis of core laboratory data.
MedLine Citation:
PMID:  14718825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The behavior of the aneurysm sac after endovascular grafting has been the subject of significant speculation. The importance of sac behavior is manifested by the correlation between aneurysm size or size change and risk for rupture, and potentially further extrapolated to define the need for secondary intervention. This study was undertaken to define graft-specific differences and the effect of endoleak on sac remodeling.
METHODS: Core laboratory data were obtained for three US Phase II clinical trials. Patients were included if they met anatomic inclusion criteria and underwent placement of the latest version of a bifurcated endovascular prosthesis. Unsupported Dacron (Ancure), supported Dacron (Zenith), and expanded polytetrafluoroethylene (Excluder) grafts were evaluated. Digitized images were electronically assessed for aneurysm size (area, maximum, minimum diameter) with National Institutes of Health Image software. Two blinded reviewers analyzed each radiographic study to ensure accurate image selection and establish the presence or absence of endoleak. A third reviewer adjudicated discrepancies. chi(2) analysis and mixed nonlinear modeling were used to analyze the results.
RESULTS: Of 1506 patients evaluated, 723 (227 Ancure, 343 Excluder, 153 Zenith) met inclusion criteria for the study. Mean follow-up was 23.2 months (Ancure, 31.3 months; Excluder, 19.6 months; Zenith, 19.3 months). The incidence of any endoleak was 39.1% (Ancure, 58.1%; Excluder, 34.7%; Zenith, 20.9%; P <.001). Type of prosthesis, presence or absence of endoleak, and baseline size were determinants of rate of aneurysm shrinkage. Reduction in sac size was greatest with the Zenith graft, followed by the Ancure and Excluder grafts. Presence of endoleak had a moderating effect on rate of sac shrinkage with the Zenith and Ancure grafts; however, sac size increased in the presence of endoleak with the Excluder graft. Finally, baseline size was positively correlated with rate of aneurysm shrinkage.
CONCLUSIONS: The behavior of the aneurysm sac depends on the type of prosthesis, presence or absence of endoleak, and baseline size of the sac. Differential sac behavior must be considered when determining the need for secondary interventions, timing follow-up studies, and assessing success or failure of endovascular repair.
Authors:
Roy K Greenberg; David Deaton; Timothy Sullivan; Esteban Walker; Sean P Lyden; Sunita D Srivastava; Kenneth Ouriel; Thomas Ivanc; Tamara Burton; Jason Mayo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  39     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-01-13     Completed Date:  2004-02-02     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  95-101     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery, The Cleveland Clinic Foundation, Desk S-40, 9500 Euclid Avenue, Clevelahd, OH 44195, USA. Greenbr@ccf.org
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MeSH Terms
Descriptor/Qualifier:
Aorta, Abdominal / physiopathology*,  surgery
Aortic Aneurysm, Abdominal / physiopathology,  surgery*
Blood Vessel Prosthesis* / adverse effects
Blood Vessel Prosthesis Implantation* / adverse effects
Clinical Trials, Phase II as Topic
Humans
Polyethylene Terephthalates
Polytetrafluoroethylene
Postoperative Complications*
Stents* / adverse effects
Chemical
Reg. No./Substance:
0/Polyethylene Terephthalates; 9002-84-0/Polytetrafluoroethylene

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


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