van Rijswijk RE, Jebbink EG, Zeebregts CJ, Reijnen MMPJ. A systematic review on anatomical predictors of abdominal aortic aneurysm remodeling after endovascular repair.
J Vasc Surg 2021;
75:1777-1785. [PMID:
34952192 DOI:
10.1016/j.jvs.2021.11.071]
[Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/23/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE
Long-term outcomes after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) are inferior to open surgical repair with regard to reinterventions and late mortality. AAA sac remodeling after EVAR has been associated with endoleaks, reinterventions, and mortality. Therefore, predictors of AAA sac remodeling could indirectly give insight into long-term EVAR outcomes. This review aims to provide an overview of the evidence on anatomical predictors of positive and negative AAA sac remodeling after EVAR.
METHODS
A systematic literature review and analysis were conducted according to the PRISMA and Cochrane guidelines. PubMed and Scopus databases were searched using terms of AAA sac growth, shrinkage, and remodeling. Eligible articles were identified and only papers that included currently used endografts were included.
RESULTS
Nineteen studies that reported on a total of 27 anatomical parameters of the aortoiliac anatomy were included. Only 4 parameters were investigated by >5 studies, 7 parameters were investigated by 3-5 studies, 6 parameters were investigated by 2 studies, and 10 parameters were investigated by 1 study. For the presence of neck thrombus, 3 out of 4 studies reported similar results indicating that it may predict less AAA sac shrinkage. AAA thrombus, total AAA volume, flow-lumen volume, and the number of hostile neck parameters were only investigated by 2-3 studies, but they seem promising in predicting sac remodeling. For hostile neck anatomy, neck length, infrarenal neck angulation, and patency of the inferior mesenteric artery, no significant association with any category of AAA sac remodeling was found.
CONCLUSIONS
This review presents neck thrombus, AAA thrombus, number of hostile neck parameters, total AAA volume, and AAA flow-lumen volume as important anatomical features that are likely to play a role in AAA remodeling after endovascular repair that should be further explored using advanced imaging techniques. This review also showed that strong consistent evidence on anatomical predictors of AAA sac remodeling after EVAR is lacking. Therefore, further research with large patient groups on a broad range of predictors of AAA sac change after EVAR is needed to complement the current gap in the evidence.
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