Key result
Small pre-EVAR AAA diameter is linked to ~62% lower risk of sac expansion or reintervention.
Why the study?
The study aimed to investigate the effects of initial abdominal aortic aneurysm diameter on aneurysmal sac expansion or shrinkage, endoleaks, and reintervention after elective simple endovascular aneurysm repair.
Does small initial AAA diameter improve freedom from aneurysmal sac expansion and/or reintervention in patients undergoing elective simple EVAR?
Cohort (n=228)
Does small initial AAA diameter improve freedom from aneurysmal sac expansion and/or reintervention in patients undergoing elective simple EVAR?
Patients with smaller initial AAA diameters undergoing EVAR have significantly higher 5-year freedom from sac expansion and reintervention compared to those with larger diameters.
Answers are grounded in this paper and cite their sources.
Smaller initial AAA diameter was associated with better post-EVAR outcomes; hypothesis-generating and should not yet change practice.
PURPOSE: We aimed to investigate the effects of initial abdominal aortic aneurysm (AAA) diameter on aneurysmal sac expansion/shrinkage, endoleaks, and reintervention postelective simple endovascular aneurysm repair (EVAR). METHODS: Overall, 228 patients monitored for >1 year after EVAR were analyzed. Male and female participants with initial AAA diameters <55 mm and <50 mm, respectively, composed the small group (group S), while those with initial AAA diameters ≥55 mm (men) and ≥50 mm (women) composed the large group (group L). Aneurysmal sac expansion of 10 mm and/or reintervention during follow-up (composite event) and its related factors were evaluated. RESULTS: The 5-year freedom from composite event rate was significantly higher in group S (92.4 ± 2.8%) than that in group L (79.1 ± 4.9%; P <0.01). Multivariate analysis revealed AAA diameters before EVAR in group S (hazard ratio, 0.38; 95% confidence interval, 0.18-0.81; P = 0.01) and type II endoleak (T2EL) at discharge (hazard ratio, 2.83; 95% confidence interval, 1.29-6.20; P <0.01) as factors associated with the composite event. The freedom from composite event rate decreased to 51 ± 13% at 5 years in group L with T2EL. CONCLUSIONS: Group S had high freedom from composite event rate; in group L, the rate decreased to 51% at 5 years with T2EL at discharge.
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Orimoto et al. (2023) conducted a cohort in Abdominal aortic aneurysm (n=228). Small initial AAA diameter (<55 mm men, <50 mm women) vs. Large initial AAA diameter (≥55 mm men, ≥50 mm women) was evaluated on 5-year freedom from composite event (aneurysmal sac expansion of 10 mm and/or reintervention) (HR 0.38, 95% CI 0.18-0.81, p=0.01). Small initial AAA diameter before EVAR was associated with a higher 5-year freedom from sac expansion or reintervention compared to large diameter (92.4% vs 79.1%; HR 0.38, 95% CI 0.18-0.81; P=0.01).
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