1. Evolution of the upper and lower landing site after endovascular aortic aneurysm repair
- Author
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Adrien Kaladji, Jean-François Heautot, Guillaume Pinel, Alain Cardon, Bruno Laviolle, Antoine Lucas, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Pharmacologie du Sepsis et Choc Septique, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Senhadji, Lotfi
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Male ,Time Factors ,[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery ,Endoleak ,030232 urology & nephrology ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Aortic aneurysm ,MESH: Blood Vessel Prosthesis ,0302 clinical medicine ,MESH: Aged, 80 and over ,Foreign-Body Migration ,[INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing ,ComputingMilieux_MISCELLANEOUS ,MESH: Treatment Outcome ,Aged, 80 and over ,MESH: Aged ,Endovascular Procedures ,MESH: Iliac Artery ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Treatment Outcome ,Female ,Stents ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,France ,MESH: Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,MESH: Aortic Aneurysm, Abdominal ,[SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing ,MESH: Prosthesis Design ,Reoperation ,medicine.medical_specialty ,MESH: Endovascular Procedures ,[INFO.INFO-TS] Computer Science [cs]/Signal and Image Processing ,MESH: Foreign-Body Migration ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,Prosthesis Design ,Aortography ,Iliac Artery ,MESH: Reoperation ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,Aneurysm ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Blood vessel prosthesis ,medicine.artery ,MESH: Analysis of Variance ,MESH: Endoleak ,medicine ,Humans ,MESH: Aortography ,In patient ,Endovascular treatment ,Renal artery ,MESH: Kaplan-Meier Estimate ,[SPI.SIGNAL] Engineering Sciences [physics]/Signal and Image processing ,Aged ,Retrospective Studies ,[SDV.IB] Life Sciences [q-bio]/Bioengineering ,Analysis of Variance ,Aortic aneurysm repair ,MESH: Humans ,business.industry ,MESH: Time Factors ,MESH: Retrospective Studies ,MESH: Blood Vessel Prosthesis Implantation ,medicine.disease ,MESH: Male ,Surgery ,Blood Vessel Prosthesis ,MESH: France ,MESH: Stents ,business ,Tomography, X-Ray Computed ,MESH: Female ,Abdominal surgery ,Aortic Aneurysm, Abdominal - Abstract
BACKGROUND: The evolution and correlation between the aortic neck and distally located iliac necks after endovascular treatment of abdominal aortic aneurysms (AAAs) was studied. METHODS: Of 179 patients who had undergone AAA repair between 2003 and 2007, 61 received the same radiologic follow-up and were included in this retrospective study. Data for 61 aortic necks and 115 iliac arteries were analyzed using the preoperative scan, 1-month visit, and final follow-up, with a minimum mean follow-up of 24 ± 15.2 months. Three measurements were taken of the aortic neck: subrenal (D1a), 15 mm below the lowest renal artery (D1b), and at the origin of the aneurysm (D1c). Three measurements were taken at the level of the iliac arteries: origin (Da), middle (Db), and the iliac bifurcation (Dc). These measurements were analyzed using analysis of variance and Spearman correlation coefficient. The results were evaluated for subsequent endoleaks, migrations, and reinterventions. All diameters were compared between patients with a regression of >10% in the greatest diameter of AAA at last follow-up (group A, n = 35) and those without (group B, n = 26). RESULTS: All diameters (in mm) increased significantly over time at the level of the proximal neck (D1a = 3.7 ± 2.8, P = .018; D1b = 4.4 ± 2.5, P = .016; D1c = 4.3 ± 3.1, P = .036) and iliac arteries (Da = 2.1 ± 0.2, P = .0006; Db = 2.5 ± 0.5, P = .0006; Dc = 3 ± 0.7, P = .007). The increase in diameters at the proximal neck and iliac arteries evolved independently (insignificant correlation), with the exception of D1b and Dc (P = .006), which showed a weak correlation (r = 0.363). The group A patients presented increases in all diameters, although to a less significant extent (P < .05) than group B patients. During follow-up, a proximal endoleak and a distal endoleak occurred, both requiring reintervention. CONCLUSIONS: Our results show a trend toward dilatation of the aortic neck and iliac arteries, with no correlation between the two levels, even in patients with a regression of the aneurysm sac during follow-up. Although this study found no correlation with the occurrence of endoleaks, our results suggest the need for a longer follow-up, especially on the landing sites.
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