O-017 - SHORTEST APPOSITION LENGTH AT THE FIRST POSTOPERATIVE COMPUTED TOMOGRAPHY ANGIOGRAPHY IDENTIFIES PATIENTS AT RISK FOR DEVELOPING A LATE TYPE IA ENDOLEAK AFTER ENDOVASCULAR ANEURYSM REPAIR

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Zuidema R. (University Medical Center Groningen ~ Groningen ~ Netherlands) , Geraedts A. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands) , Schuurmann R. (University Medical Center Groningen ~ Groningen ~ Netherlands) , Kwant A. (University Medical Center Groningen ~ Groningen ~ Netherlands) , Mulay S. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands) , Balm R. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands) , De Vries J. (University Medical Center Groningen ~ Groningen ~ Netherlands)
Introduction:
Imaging surveillance following endovascular aneurysm repair (EVAR) is strictly recommended. This study investigates the value of endograft apposition and position relative to the aortic neck on the first postoperative computed tomography angiography (CTA) in determining patients at risk for a late type Ia endoleak (T1aEL).
Methods:
Patients with a T1aEL after the first postoperative CTA were selected from a consecutive database and matched with uncomplicated controls. Endograft apposition and position, including the shortest apposition length (SAL), were determined on the first postoperative CTA. The SAL is the shortest distance between the proximal endograft fabric and the first slice where circumferential apposition with the aortic wall is lost (Figure 1). Differences in endograft apposition at the first postoperative CTA were compared between groups. Logistic regression analysis identified independent predictors for late T1aEL.
Results:
32 patients with a late T1aEL were included and matched with 32 uncomplicated controls. Median follow-up after primary EVAR was 62.0 (IQR 36.8, 83.5) months in the T1aEL group compared to 47.5 (IQR 34.0, 79.3) months in the control group; p=0.265. Median preoperative neck diameter was significantly larger in the T1aEL group than in the control group (26.6 [IQR 24.9, 29.6] mm versus 23.4 [IQR 22.5, 25.3] mm); p<0.001. Patients in the T1aEL group had a median SAL of 11.6 (IQR 4.3, 20.5) mm compared to 20.7 (IQR 13.1, 24.9) mm in the control group; p=0.002. SAL <10mm on the first postoperative CTA (OR 9.63, 95% CI 1.60-57.99) and larger neck diameter (OR 1.80, 95% CI 1.26-2.57) were independent predictors for developing a late T1aEL.
Conclusion:
Preoperative neck diameter and SAL on the first postoperative CTA following EVAR are important predictors for the development of a late T1aEL. Patients with a SAL of <10mm had a significantly higher risk of developing a late T1aEL. Future research should determine whether these patients would benefit from re-intervention before an actual T1aEL is present.
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