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Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair

2017-02Journal article Open access
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dc.contributor.authorBastos Gonçalves, F
dc.contributor.authorOliveira, NF
dc.contributor.authorJosee van Rijn, M
dc.contributor.authorUltee, KH
dc.contributor.authorHoeks, SE
dc.contributor.authorTen Raa, S
dc.contributor.authorStolker, RJ
dc.contributor.authorVerhagen, HJ
dc.date.accessioned2017-03-15T16:12:47Z
dc.date.available2017-03-15T16:12:47Z
dc.date.issued2017-02
dc.description.abstractOBJECTIVE: To evaluate the dynamics of the iliac attachment zone after EVAR, and the association with clinical events. METHODS: A tertiary institution's prospective EVAR database was searched to identify common iliac arteries at risk. Internally validated measurements were made, using centre lumen line reconstructions. Iliac dilatation and endograft limb retraction were the main endpoints. Associations between dilatation, retraction, oversizing, and distal seal length were investigated. Association with clinical events (sealing or occlusion) was also explored. RESULTS: Of 452 primary EVAR patients treated from 2004 to 2012, 341 were included (mean age 72 years, 12% female, 597 common iliac arteries). Median follow-up was 4.7 years. At 30 days, the mean iliac diameter increased from 14 mm to 15 mm (p < .001). Over follow-up, it increased to 18 mm (p < .001). Iliac dilatation ≥20% occurred in 295 cases (49.4%) and exceeded the implanted endograft diameter in 170 (28.7%). Limb retraction ≥5 mm was identified in 54 patients (9.1%) and was associated with iliac seal complications (p < 0.001). Iliac endograft extension diameter ≥24 mm (OR 3.3, 95% CI 1.7-6.4) and iliac artery dilatation beyond the endograft (OR 2.1, 95% CI 1.2-3.8) were independent risk factors. Overall, there were 34 (5.7%) iliac seal complications. Retraction of the iliac endograft (OR 1.17 per mm, 95% CI 1.10-1.24) and baseline AAA diameter (1.04 per mm, 95% CI 1.01-1.07) were independent risk factors for seal related complications. Greater initial post-operative iliac seal length was protective (OR 0.94 per mm, 95% CI 0.90-0.97). CONCLUSIONS: Iliac dilatation and endograft retraction are common findings during follow-up, potentially leading to adverse clinical events. Optimisation of the iliac seal zone providing a long distal seal length and added attention to patients with large aneurysms or receiving ≥24 mm diameter iliac extensions are recommended. Also, long-term surveillance including CTA is advised to reveal and correct loss of seal at the iliac attachments before adverse clinical events occur.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationEur J Vasc Endovasc Surg. 2017 Feb;53(2):185-192.pt_PT
dc.identifier.doi10.1016/j.ejvs.2016.11.003pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2637
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectCHLC CIR VASCpt_PT
dc.subjectAortic Aneurysm/diagnostic imagingpt_PT
dc.subjectAortic Aneurysm/physiopathologypt_PT
dc.subjectAortic Aneurysm/surgerypt_PT
dc.subjectBlood Vessel Prosthesispt_PT
dc.subjectBlood Vessel Prosthesis Implantation/adverse effectspt_PT
dc.subjectBlood Vessel Prosthesis Implantation/instrumentationpt_PT
dc.subjectComputed Tomography Angiographypt_PT
dc.subjectDatabases, Factual
dc.subjectDilatation, Pathologic
dc.subjectEndoleak/diagnostic imaging
dc.subjectEndoleak/etiology
dc.subjectEndoleak/physiopathology
dc.subjectEndovascular Procedures/adverse effects
dc.subjectEndovascular Procedures/instrumentation
dc.subjectIliac Artery/diagnostic imaging
dc.subjectIliac Artery/physiopathology
dc.subjectIliac Artery/surgery
dc.subjectProsthesis Design
dc.subjectRetrospective Studies
dc.subjectRisk Factors
dc.subjectTime Factors
dc.subjectTertiary Care Centers
dc.subjectTreatment Outcome
dc.titleIliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repairpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage192pt_PT
oaire.citation.issue2pt_PT
oaire.citation.startPage185pt_PT
oaire.citation.titleEuropean Journal of Vascular and Endovascular Surgerypt_PT
oaire.citation.volume53pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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