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Impact of Endoluminal Treatment on Small Abdominal Aortic Aneurysm: Aneurysm Sac Regression and Secondary Interventions With 5 Years of Follow-Up

Division of Vascular Surgery, Harbor-UCLA UCLA Medical Center, Torrance, California, haobui{at}comcast.net

Ricardo Lujan, MD

Division of Vascular Surgery, Harbor-UCLA UCLA Medical Center, Torrance, California

Alex Nguyen, MD

Division of Vascular Surgery, Harbor-UCLA UCLA Medical Center, Torrance, California

Carlos Donayre, MD

Division of Vascular Surgery, Harbor-UCLA UCLA Medical Center, Torrance, California

Lauren Lee

Division of Vascular Surgery, Harbor-UCLA UCLA Medical Center, Torrance, California

Irwin Wallot, MD

Division of Radiology, Harbor-UCLA UCLA Medical Center, Torrance, California

George Kopchock

Division of Vascular Surgery, Harbor-UCLA UCLA Medical Center, Torrance, California

Maurice Lippmann, MD

Division of Anesthesiology Harbor-UCLA UCLA Medical Center, Torrance, California

Rodney White, MD

Division of Vascular Surgery, Harbor-UCLA UCLA Medical Center, Torrance, California

Does early repair of small abdominal aortic aneurysms (AAAs) lead to faster aneurysm sac regression or less secondary intervention? Computed tomography scans and reconstructions from M2S of all patients undergoing endovascular AAA repair at our institution from 1996 to 2006 were retrospectively reviewed. A small aneurysm is defined as an aneurysm sac to renal diameter ratio of less than 2. There were 374 patients with endovascular AAA repair that had complete imaging studies. There were 75 patients (20%) with small AAAs; of those, 19 patients (25.3%) had endoleak compared with 108 patients (36.1%) with a large aneurysm ( P = .1). Over a mean follow-up time of 42 months (range, 1-109), 11 small AAAs (14.7%) had secondary interventions compared with 58 (19.4%) of the large AAAs (P = .41). Small AAAs at 5 years had a 2.5% volume sac regression but a 3.0% increase in diameter. Those with a large aneurysm had a slight increase in sac volume and diameter at 1 month (3.3%, 1.4%) and then steadily decreased to —13.4% and —8.8% at 5 years. Patients with Endologix (Endologix Inc., Irvine, Calif) devices have the most regression when compared with patients with AneuRx (Medtronic Inc., Minneapolis, Minn) and Talent (Medtronic Inc., Minneapolis, Minn) devices. Early endovascular intervention in small AAAs does not result in faster aneurysm sac regression or secondary intervention. Aneurysm sac regression is significantly affected by endoleak, aneurysm size, and device used.

Key Words: abdominal aortic aneurysm • sac regression • endovascular repair • endoleak • secondary interventions

Vascular and Endovascular Surgery, Vol. 41, No. 4, 294-300 (2007)
DOI: 10.1177/1538574407301142


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