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Risk Factors, Dynamics, and Clinical Consequences of Aortic Neck Dilatation after Standard Endovascular Aneurysm Repair

2021Journal article Open access
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dc.contributor.authorOliveira, N
dc.contributor.authorOliveira-Pinto, J
dc.contributor.authorRijn, M
dc.contributor.authorBaart, S
dc.contributor.authorRaa, S
dc.contributor.authorHoeks, S
dc.contributor.authorBastos Gonçalves, F
dc.contributor.authorVerhagen, H
dc.date.accessioned2022-06-15T14:43:18Z
dc.date.available2022-06-15T14:43:18Z
dc.date.issued2021
dc.description.abstractObjective: Aortic neck dilatation (AND) occurs after endovascular aneurysm repair (EVAR) with self expanding stent grafts (SESs). Whether it continues, ultimately exceeding the endograft diameter leading to abdominal aortic aneurysm (AAA) rupture, remains uncertain. Dynamics, risk factors, and clinical relevance of AND were investigated after EVAR with standard SESs. Methods: All intact EVAR patients treated from 2000 to 2015 at a tertiary institution were included. Demographic, anatomical, and device related characteristics were investigated as risk factors for AND. Outer to outer diameters were measured at a single standardised aortic level on reconstructed computed tomography (CT) images. Results: A total of 460 patients were included (median follow up 5.2 years, interquartile range [IQR] 3.0, 7.7 years; CT imaging follow up 3.3 years, IQR 1.3, 5.4). Baseline neck diameter was 24 mm (IQR 22, 26) and increased 11.1% (IQR 1.5%, 21.9%) at last CT imaging. Endograft oversizing was 20.0% (IQR 13.6, 28.0). AND was greater during the first year (5.2% [IQR 0, 11.7]) decreasing subsequently (two to four years to 1.4%/year [IQR 0.0, 4.5%], p ≤ .001) and was associated with suprarenal fixation endografts (t value = 7.9, p < .001) and oversizing (t value = 4.4, p < .001). AND exceeding the endograft was 3.5% (95% CI 2.2% - 4.8%) and 14.4% (95% CI 11.0% - 17.8%) at five and eight years, respectively. Excessive AND was associated with baseline neck diameter (OR 1.2/mm, 95% CI 1.05 - 1.41) while the Excluder endograft had a protective effect (OR 0.15, 95% CI 0.04 - 0.58). Excessive AND was associated with type 1A endoleak (HR 3.3, 95% CI 1.1 - 9.7) and endograft migration > 5 mm (HR 3.1, 95% CI 1.4 - 6.9). Conclusion: AND after EVAR with SES is associated with endograft oversizing and radial force but decelerates after the first post-operative year. Baseline aortic neck diameter and suprarenal stent bearing endografts were associated with an increased risk of AND beyond nominal stent graft diameter. However, it remains unclear whether patient selection, differences in endograft radial force or the suprarenal stent are accountable for this difference.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationEur J Vasc Endovasc Surg. 2021 Jul;62(1):26-35.pt_PT
dc.identifier.doi10.1016/j.ejvs.2021.03.020.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4119
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectHSM CIR VASCpt_PT
dc.subjectAgedpt_PT
dc.subjectFemalept_PT
dc.subjectMalept_PT
dc.subjectHumanspt_PT
dc.subjectNeckpt_PT
dc.subjectRisk Factorspt_PT
dc.subjectAorta, Abdominal / diagnostic imagingpt_PT
dc.subjectAorta, Abdominal / surgerypt_PT
dc.subjectAortic Aneurysm, Abdominal / complicationspt_PT
dc.subjectAortic Aneurysm, Abdominal / surgery*pt_PT
dc.subjectAortic Rupture / epidemiology*pt_PT
dc.subjectAortic Rupture / etiologypt_PT
dc.subjectAortographypt_PT
dc.subjectComputed Tomography Angiographypt_PT
dc.subjectDilatation, Pathologic / diagnosispt_PT
dc.subjectDilatation, Pathologic / epidemiologypt_PT
dc.subjectDilatation, Pathologic / etiologypt_PT
dc.subjectForeign-Body Migration / epidemiology*pt_PT
dc.subjectForeign-Body Migration / etiologypt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectRisk Factorspt_PT
dc.subjectStents / adverse effectspt_PT
dc.subjectTreatment Outcomept_PT
dc.titleRisk Factors, Dynamics, and Clinical Consequences of Aortic Neck Dilatation after Standard Endovascular Aneurysm Repairpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage35pt_PT
oaire.citation.startPage26pt_PT
oaire.citation.titleEuropean Journal of Vascular and Endovascular Surgerypt_PT
oaire.citation.volume62pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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