LATE ABDOMINAL AORTIC ANEURISMATIC SAC RETRACTION AFTER EVAR

  • André Filipe Viseu dos Santos Escola de Medicina da Universidade do Minho
  • Mário Marques Vieira Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga
  • Luís Vilaça Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga
  • Ana Ferreira Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga
  • João Oliveira Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga
  • António Assunção Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga
Keywords: Abdominal Aortic Aneurysm, Graft, Aneurismatic sac retraction

Abstract

Introdution: In the last years, EVAR has been increasingly affirmed as the main surgical option for AAA correction without rupture. This procedure presents specific clinical and anatomical indications although it does not prevent the appearance of long-term complications associated with EVAR.

Materials and Methods: A retrospective study of all patients submitted to EVAR was performed at the Hospital under study, between 01/01/2010 and 12/31/2016. After selection of 52 patients, applied the exclusion criteria, a total of 26 patients were obtained. This sample was Statistic analysed in order to evaluate the existence of any factor that relates or allows predicting aneurysmal retraction after an EVAR.

Results: Correlation tests were performed, where only the variable Smoking History showed Statistic significance (Pearson r=-,390; p=0.049). This change was later verified with a comparison of means where it was verified that there was a significant difference between the groups with history of smoking (the one with the greatest retraction) and the group without smoking history. The influence of this variable on the retraction was verified through the Linear Regression analysis, in which statistical significance was verified (p = 0.032, B = −6.538), confirming the influence on the retraction. In a linear regression analysis for the remaining variables, although there was no significant difference, the variable largest diameter of the neck was the one that presented the greatest influence on the retraction, with B = 8.047 and p value closer to significance (p = 0.058). In the Binary Regression only the variable % thrombus in the neck presented significance outside the equation, showing no statistical significance (p = 0.071; Exp (B) = 0,121) in the equation.

Conclusion: In summary, this study allows us to infer that the performance of EVAR in patients with AAA presents better results when patients have a personal history of smoking. In addition, there is a tendency for the existence of a relation between the variable % thrombus in the cervix with the AAA retraction after EVAR.

Downloads

Download data is not yet available.

References

1. Ferro, G. (2012). Aspectos epidemiológicos, etiopatogênicos, clínicos, diagnósticos e terapêuticos do aneurisma de aorta abdominal. Enciclopédia Biosfera, 1510–1520.

2. Castro-Ferreira, R. (2016). Rastreio populacional de aneurisma da aorta abdominal em Portugal — o imperativo da sua realização. Sociedade portuguesa de angiologia e cirurgia vascular, 267–270.

3. England, A. (2013). Endovascular Aortic Aneurysm Repair (EVAR). The Ulster Medical Society, 3–10.

4. Keller, E. (2009). Correção endovascular do AAA. Revista Bras Cirurgia Cardiovascar, Suplemento: 49s-52s.

5. Ellozy, S. H. (2006). Abdominal aortic aneurysm sac shrinkage after endovascular aneurysm repair: Correlation with chronic sac pressure measurement. Journal of vascular surgery, 2–7.

6. Ghouri, M. (2010). Endoluminal Abdominal Aortic Aneurysm Repair. Texas Heart Institute Journal, 19–24.

7. Nakai, M. (2015). Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair. Turkish Society of Radiology .

8. Maarit, H. (2006). The importance of iliac fixation in prevention of stent graft migration. JOURNAL OF VASCULAR SURGERY, 1129–1137.

9. Chagas Neto FA. (2010). A importância do diagnóstico por imagem na classificação dos endoleaks como complicação do tratamento endovascular de aneurismas aórticos. Radiol Bras. 289–294.

10. Chikazawa, G. (2014). Influencing Factors for Abdominal Aortic Aneurysm Sac Shrinkage and Enlargement after EVAR: Clinical Reviews before Introduction of Preoperative Coil Embolization. Annals of Vascular Diseases, 280–285.

11. Cho, J.-S. (2004). Late abdominal aortic aneurysm enlargement after endovascular repair with the Excluder device. JOURNAL OF VASCULAR SURGERY, 1236–1241.

12. F Bastos, G. (2014). Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair. The British Journal of Surgery, 802–810.

Livros:
13. Bratby, M. (2010). Endovascular Aneurysm Repair (EVAR). Oxford Radcliffe Hospitals NHS Trust. Londres.

WebSites:
14. Endovascular Repair of Abdominal Aortic Aneurysms. Obtido de
Society for Vascular Surgery: citado a 16/06/2017. Disponivel a partir
de: https://vascular.org/patient-resources/vascular-treatments/endovascular-repair-abdominal-aortic-aneurysms
Published
2018-12-21
Section
Original Article