Academic Journal
Proximal Seal after Emergency EVAR for Ruptured Abdominal Aortic Aneurysm and its Clinical Implications.
| Τίτλος: | Proximal Seal after Emergency EVAR for Ruptured Abdominal Aortic Aneurysm and its Clinical Implications. |
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| Συγγραφείς: | Hijkoop LF; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: l.f.hijkoop@umcg.nl., Accarino GA; Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy., van Veldhuizen WA; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Tielliu IFJ; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Hendricks CHF; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., van Lammeren GW; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands., Kropman RHJ; Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands., de Vries JPM; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. |
| Πηγή: | Annals of vascular surgery [Ann Vasc Surg] 2026 Oct; Vol. 131, pp. 51-60. Date of Electronic Publication: 2026 Jun 10. |
| Τύπος έκδοσης: | Journal Article; Observational Study; Multicenter Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 8703941 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1615-5947 (Electronic) Linking ISSN: 08905096 NLM ISO Abbreviation: Ann Vasc Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2007->: Netherlands : Elsevier Original Publication: Detroit : [Published by Expansion scientifique française for Annals of Vascular Surgery, Inc. and Association pour la promotion de la chirurgie vasculaire, Paris, c1986- |
| Ιατρικοί όροι (MeSH): | Aortic Aneurysm, Abdominal*/surgery , Aortic Aneurysm, Abdominal*/diagnostic imaging , Aortic Aneurysm, Abdominal*/mortality , Aortic Rupture*/surgery , Aortic Rupture*/diagnostic imaging , Aortic Rupture*/mortality , Blood Vessel Prosthesis Implantation*/adverse effects , Blood Vessel Prosthesis Implantation*/mortality , Blood Vessel Prosthesis Implantation*/instrumentation , Endoleak*/etiology , Endoleak*/diagnostic imaging , Endoleak*/therapy , Endovascular Aneurysm Repair*/adverse effects , Endovascular Aneurysm Repair*/mortality , Endovascular Aneurysm Repair*/instrumentation, Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Blood Vessel Prosthesis ; Computed Tomography Angiography ; Emergencies ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome |
| Περίληψη: | Objective: Endograft apposition can predict failure after elective endovascular aneurysm repair (EVAR), but its role in ruptured EVAR (rEVAR) has not been investigated separately. This study evaluates early to mid-term outcomes after rEVAR, including proximal apposition and its changes over time. Methods: In this retrospective, observational, dual-center study of consecutive rEVAR patients, treated between January 2015 and December 2024, aortic morphology and proximal endograft apposition were analyzed. Shortest apposition length (SAL) was measured on early (<3 months) and last postoperative computed tomography angiography (CTA). Records were reviewed for baseline characteristics, complications, and reinterventions. SAL changes were assessed and compared between patients with and without type 1a endoleak (T1aEL). Overall survival was estimated using Kaplan-Meier analysis. Cumulative incidences of T1aEL and reinterventions were assessed using competing risk analysis accounting for mortality. Results: Included were 89 patients. Median follow-up was 47 months (95% confidence interval, 37-71 months). Thirty-four patients (38%) were treated outside of the instructions for use for the proximal neck. Median SAL was 13.7 mm (6.4, 21.8 mm), with 39% (n = 35) having a SAL of <10 mm, as measured on the early CTA. SAL on the early CTA did not differ significantly between patients with and without mid-term T1aEL (10.7 mm [6.5, 19.7 mm] vs. 15.1 mm [8.1, 22.4 mm], P = 0.544). For mid-term T1aEL patients, SAL had diminished and was shorter on the pre-endoleak CTA compared to the SAL on the last CTA of patients without mid-term T1aEL (4.2 mm [0.0, 7.6 mm] vs. 18.5 mm [11.5, 27.0 mm], P = 0.014). Conclusion: Short proximal SAL (<10 mm) occurred frequently; however, due to the limited number of mid-term T1aELs, no statistical association could be confirmed between initial short SAL and mid-term T1aELs. A low SAL combined with a decrease during follow-up appeared to be linked to the development of mid-term T1aELs. Serial CTA-applied SAL assessment may help identify patients at risk for T1aEL, guide follow-up, and improve long-term outcomes after rEVAR. (Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.) |
| Entry Date(s): | Date Created: 20260610 Date Completed: 20260803 Latest Revision: 20260825 |
| Update Code: | 20260826 |
| DOI: | 10.1016/j.avsg.2026.05.093 |
| PMID: | 42269912 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1615-5947 |
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| DOI: | 10.1016/j.avsg.2026.05.093 |