دورية أكاديمية
The Ratio Between the Infrarenal and Suprarenal Aortic Diameter Is a Predictor of Durable Proximal Seal After Endovascular Aneurysm Repair.
| العنوان: | The Ratio Between the Infrarenal and Suprarenal Aortic Diameter Is a Predictor of Durable Proximal Seal After Endovascular Aneurysm Repair. |
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| المؤلفون: | Jan Boer G; Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands., Bekken JA; Department of Vascular Surgery, NoordWest Hospitalgroup, Haarlem, The Netherlands., Kuijper TM; Maasstad Academy, Maasstad Hospital, Rotterdam, The Netherlands., Vroegindeweij D; Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands., Fioole B; Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands. |
| المصدر: | Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Feb 07, pp. 15266028241228803. Date of Electronic Publication: 2024 Feb 07. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Sage Publications Country of Publication: United States NLM ID: 100896915 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1545-1550 (Electronic) Linking ISSN: 15266028 NLM ISO Abbreviation: J Endovasc Ther Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2015- : Thousand Oaks, CA : Sage Publications Original Publication: Phoenix, AZ : The Society, c2000- |
| مستخلص: | Objectives: The aim of this study was to assess whether the ratio of the mean infrarenal neck diameter to the suprarenal aortic diameter is a predictor for a durable proximal seal after endovascular aneurysm repair (EVAR). Methods: A total of 439 patients who underwent elective EVAR between 2004 and 2018 in a single vascular referral center met our inclusion criteria. Ratios were calculated by dividing the mean infrarenal neck diameter by 4 different suprarenal aortic diameters. Patients who developed a late type 1A endoleak (n=20) or proximal neck dilatation mandating revision (n=8) were compared with the 411 patients without long-term proximal seal complications. Results: Patients who developed a late type 1A endoleak had more frequently hypertension, a shorter infrarenal neck length, and a larger mean infrarenal neck diameter. The ratio of the mean infrarenal neck diameter to all 4 suprarenal aortic diameters was higher in the late type 1A endoleak group compared with the group without a late type 1A endoleak. Least absolute shrinkage and selection operator (LASSO) logistic regression identified a combination of 6 variables as the best combination to predict a late type 1A endoleak: presence of hypertension, increased mean infrarenal neck diameter, decreased aneurysm neck length, larger ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the superior mesenteric artery (SMA), larger ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the upper renal artery, and increased β-angle. Of these, based on both the univariate area under the curve (AUC) and optimal LASSO model restricted to a single predictor, the ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the SMA (AUC, 0.770; cutoff value, 0.997) was considered the best prognostic variable. Conclusion: The ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the SMA is a good predictor for a late type 1A endoleak. Patients with mean infrarenal neck diameter larger than the diameter proximal to the SMA (ratio >1) are at risk for a late type 1A endoleak. Clinical Impact: In this single-center, retrospective cohort study, we found that the ratio of the mean infrarenal neck diameter to the aortic diameter proximal to the SMA is a good predictor for a late type 1A endoleak. We conclude that the suprarenal diameter must be taken into account before assessing endovascular aortic aneurysm repair eligibility. Patients with a ratio >1 may not be the best candidates for a durable result after EVAR and may be better off with fenestrated EVAR or open repair. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| فهرسة مساهمة: | Keywords: EVAR; aneurysm neck diameter; aneurysm neck length; aortic abdominal aneurysm; suprarenal diameter; type 1A endoleak |
| تواريخ الأحداث: | Date Created: 20240207 Latest Revision: 20240207 |
| رمز التحديث: | 20240207 |
| DOI: | 10.1177/15266028241228803 |
| PMID: | 38323563 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1545-1550 |
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| DOI: | 10.1177/15266028241228803 |