Aneurysm Neck Diameter after Endovascular Repair of Abdominal Aortic Aneurysms

Badran, Mohammad F.; Gould, Derek A.; Raza, Irfan; McWilliams, Richard G.; Brown, Oliver; Harris, Peter L.; Gilling-Smith, Geoffrey L.; Brennan, John; White, Donna; Meakin, Shaun; Rowlands, Peter C.

doi:10.1016/S1051-0443(07)61771-0

« Previous Next »Journal of Vascular and Interventional Radiology
Volume 13, Issue 9, Part 1 , Pages 887-892, September 2002

Aneurysm Neck Diameter after Endovascular Repair of Abdominal Aortic Aneurysms

Mohammad F. Badran, MD
- Address correspondence to M.F.B.
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
- These authors have indicated the existence of a potential conflict of interest. None of the other authors has identified a conflict of interest.
Derek A. Gould, MD
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
Irfan Raza
- Department of Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
Richard G. McWilliams, MD
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
Oliver Brown, MD
- Department of Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
- These authors have indicated the existence of a potential conflict of interest. None of the other authors has identified a conflict of interest.
Peter L. Harris, MD
- Department of Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
Geoffrey L. Gilling-Smith, MD
- Department of Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
John Brennan, MD
- Department of Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
Donna White, DCR(R)
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
Shaun Meakin, SRN
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom
Peter C. Rowlands, MD
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom

Received 20 February 2002; received in revised form 8 April 2002 and 15 May 2002; accepted 16 May 2002.

PURPOSE

To determine aneurysm neck diameter change after endovascular repair (EVR) of abdominal aortic aneurysm (AAA) and its relationship to stent-graft diameter.

MATERIALS AND METHODS

The cases of 73 patients with AAAs who underwent EVR were reviewed retrospectively: 68 had preoperative imaging available. Neck diameter was reviewed by a single observer (M.F.B.) on preoperative, immediate postoperative, annual, and most recent contrast-enhanced computed tomographic scans. Baseline and follow-up neck diameters were compared with the manufacturers' values for unconstrained stent-graft diameters.

RESULTS

Intraobserver error was 2 mm. Aneurysm neck diameter increased from 21.8 mm (range, 17–28 mm) at baseline to 22.8 mm (range, 19–30 mm) postoperatively and 25.8 mm (range, 19–31 mm; P < .001) at a mean follow-up of 25.5 months (range, 6.2–60.8 mo). Neck diameter increase was more than 2 mm in 24 patients (33%). Mean change in the first, second, third, and fourth years was +1.63 mm, +0.52 mm, +0.25 mm, and +0.33 mm, respectively. Baseline mean stent-graft oversizing was 2.9 mm (13.7%; range, +1to +8 mm), which decreased to 0.7 mm (range, +4to +6 mm) at latest follow-up. Neck diameter exceeded stent-graft diameter (mean, 1.8 mm; range, 1–4 mm) in 21 cases (28%) and by more than 2 mm in five cases (6.8%). When neck diameter change was correlated with change in sac diameter, it was found to be insignificant (P = .24); however, it was significantly correlated with baseline oversizing (P = .01).

CONCLUSIONS

After EVR, the aneurysm neck dilates, mostly in the first 2 years, by greater than 2 mm in one third of patients. This is possibly related to the presence of the endograft. The associated reduction of stent-graft oversizing warrants continued vigilance for proximal endoleak.

Index terms: Aneurysm, abdominal , Aneurysm, aortic , Endovascular stent-grafts , Stents and prostheses

Abbreviations: AAA, abdominal aortic aneurysm , EVR, endovascular repair