Key result
A model including cross-sectional area of the aortic lumen at the IMA and number of aortic side branches predicted IMA type II endoleaks with 78% sensitivity and 79% specificity.
Why the study?
Do pre-operative morphologic parameters on CT angiography predict the development of IMA type II endoleaks in patients undergoing EVAR for infrarenal abdominal aortic aneurysm?
Observational (n=322)
Do pre-operative morphologic parameters on CT angiography predict the development of IMA type II endoleaks in patients undergoing EVAR for infrarenal abdominal aortic aneurysm?
Pre-operative CT angiographic parameters, specifically the cross-sectional area of the aortic lumen at the IMA ostium and the number of patent aortic side branches, can predict the risk of IMA type II endoleaks after EVAR.
Answers are grounded in this paper and cite their sources.
May aid pre-EVAR risk stratification for IMA type II endoleaks; leaves open need for prospective validation before clinical use.
PURPOSE: To evaluate the association of inferior mesenteric arterial (IMA) type II endoleaks in patients undergoing endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm with several morphologic parameters. MATERIALS AND METHODS: Approval of the institutional ethical review committee was not required. This was a retrospective review of 322 computed tomographic angiographic studies that were performed in patients before they underwent elective EVAR for infrarenal abdominal aortic aneurysm. Morphologic parameters evaluated were IMA patency, origin of the IMA in relation to the aneurysm sac, diameter of the IMA, the cross-sectional area of the contrast material-enhanced aortic lumen at the level of the IMA ostium, and the number of additional patent aortic side branches from the aneurysm sac. The association of IMA type II endoleaks with each variable was analyzed by using univariate and multivariate logistic regression models. RESULTS: The diameter of the IMA did not influence the development of IMA type II endoleaks (P = .51). The incidence of these endoleaks was significantly higher in patients with greater cross-sectional area of the aortic lumen at the IMA ostium (P < .001). Patients with an IMA type II endoleak had significantly more patent aortic side branches before EVAR than did patients without an endoleak (3.6 ± 1.7 vs 2.2 ± 1.4; P < .001). According to the final logistic regression model that included cross-sectional area of the aortic lumen at the IMA and the number of aortic side branches as independent predictors, risk for IMA type II endoleaks was determined with a sensitivity of 78% (39 of 50) and a specificity of 79% (92 of 116). CONCLUSION: Cross-sectional area of the contrast-enhanced aortic lumen at the level of the IMA ostium and the number of additional patent aortic side branches are associated with the development of IMA type II endoleaks.
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Güntner et al. (2013) conducted an observational in Infrarenal abdominal aortic aneurysm (n=322). Morphologic parameters (cross-sectional area of aortic lumen at IMA ostium and number of patent aortic side branches) was evaluated on Development of inferior mesenteric arterial (IMA) type II endoleaks (p=<0.001). A model including cross-sectional area of the aortic lumen at the IMA and number of aortic side branches predicted IMA type II endoleaks with 78% sensitivity and 79% specificity.
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