Academic Journal
Improved Endovascular Aortic Repair Durability in Patients Achieving Increased Shortest Apposition Length: A Multi-Centre Analysis.
| Τίτλος: | Improved Endovascular Aortic Repair Durability in Patients Achieving Increased Shortest Apposition Length: A Multi-Centre Analysis. |
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| Συγγραφείς: | Hendricks CHF; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands., Schuurmann RCL; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands., Fioole B; Division of Vascular Surgery, Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands., Kropman RHJ; Division of Vascular Surgery, Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands., Bokkers RPH; Division of Interventional Radiology, Department of Radiology, University Medical Centre Groningen, Groningen, the Netherlands., van Dam L; Division of Interventional Radiology, Department of Radiology, Maasstad Hospital, Rotterdam, the Netherlands., Vos JA; Division of Interventional Radiology, Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands., de Vries JPM; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands. |
| Πηγή: | Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2026 Oct; Vol. 33 (5), pp. 2429-2438. Date of Electronic Publication: 2025 May 13. |
| Τύπος έκδοσης: | Journal Article; Multicenter Study; Observational Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | 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 |
| Imprint Name(s): | Publication: 2015- : Thousand Oaks, CA : Sage Publications Original Publication: Phoenix, AZ : The Society, c2000- |
| Ιατρικοί όροι (MeSH): | Aortic Aneurysm, Abdominal*/surgery , Aortic Aneurysm, Abdominal*/diagnostic imaging , Aortic Aneurysm, Abdominal*/physiopathology , Endoleak*/etiology , Endoleak*/diagnostic imaging , Endoleak*/therapy , Endovascular Aneurysm Repair*/adverse effects , Endovascular Aneurysm Repair*/instrumentation, Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Aortography ; Blood Vessel Prosthesis ; Computed Tomography Angiography ; Netherlands ; Progression-Free Survival ; Prosthesis Design ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome |
| Περίληψη: | Objective: Endovascular aortic repair (EVAR) for an aneurysm of the abdominal aorta (AAA) is associated with long-term complications, such as endoleaks, resulting in a significant re-intervention rate. This study investigates the prognostic value of (change of) proximal seal length on post-EVAR computed tomography angiography (CTA) for predicting type 1a endoleak. It further proposes a risk-stratified imaging follow-up algorithm. Design: Multicentre, retrospective, observational study of consecutive patients who underwent elective EVAR for infrarenal AAA between 2015 and 2018 at 3 high-volume hospitals in the Netherlands. Materials and Methods: Aorta morphology and endograft position analysis was performed. Shortest apposition length (SAL) was measured on the first post-EVAR CTA and, if available, on the last CTA. Change of SAL through time was categorized as increasing, stable, or decreasing and correlated with type 1a endoleak and secondary interventions for endoleak. Kaplan-Meier analysis was used to calculate type 1a endoleak free and re-intervention-free survival. Results: Three hundred ten AAA patients with a median follow-up of 51 (Q1, 17; Q3, 71) months were included. A median SAL of 22.8 mm (Q1, 15.9; Q1, 30.4) was measured on the first post-EVAR CTA. In 168 of 310 patients (54%), a second post-EVAR CTA was available, in which 71 (42%) showed increasing SAL over time. No type 1a endoleak developed in the increasing SAL group, whereas 1 of 43 (2%) in the stable group and 10 of 54 (19%) in the decreasing group developed type 1a endoleak. Five years post-EVAR, type 1a endoleak-free survival was 100% in the increasing SAL group versus 97.1% in the stable SAL group (p=0.195), and 81.6% in the decreasing SAL group (p<0.001). The re-intervention for all types of endoleak-free survival was 100% in the increasing SAL group versus 84.6% in the stable SAL group (p<0.001), and 60.7% (p<0.001) in the decreasing SAL group. Conclusion: Increasing SAL after EVAR for infrarenal degenerative AAA is an indicator of durable success without type 1a endoleak and endoleak-associated secondary intervention within 5 years. Decreasing SAL is associated with development of type 1a endoleak after EVAR. Evaluation of (change of) the proximal seal could be a valuable part of follow-up after EVAR.Clinical ImpactEvaluation of proximal seal length after endovascular aortic repair offers valuable prognostic information regarding the risk of type 1a endoleak. Implementation could refine current follow-up algorithms to better stratify patients who have a substantial risk of type Ia endoleak from patients who may benefit from limited image surveillance. |
| Competing Interests: | Declaration of Conflicting InterestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.P.V. and R.S. are co-founders of the company Endovascular Diagnostics B.V., which holds patent rights over the software used to determine endograft apposition and position. C.H., B.F., R.K., R.B., L.D., and J.-A.V. have no conflicts of interest. |
| Contributed Indexing: | Keywords: abdominal aortic aneurysm; endoleak; endovascular aneurysm repair; seal; shortest apposition length |
| Entry Date(s): | Date Created: 20250513 Date Completed: 20260916 Latest Revision: 20260918 |
| Update Code: | 20260919 |
| PubMed Central ID: | PMC13570999 |
| DOI: | 10.1177/15266028251338812 |
| PMID: | 40357763 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1545-1550 |
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| DOI: | 10.1177/15266028251338812 |