J Korean Soc Radiol.  2013 Feb;68(2):87-97. 10.3348/jksr.2013.68.2.87.

Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

• Lee YY
• Song JH
• Kim YT
• Kim SH
• Yim NY
• Chang NK
• Kim JK
• Lee HK
• Choi SJ
• Chung SY

• KMID: 2097986
• DOI: http://doi.org/10.3348/jksr.2013.68.2.87

Abstract

PURPOSE
To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms.
MATERIALS AND METHODS
Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed.
RESULTS
A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7).
CONCLUSION
EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

MeSH Terms

Aneurysm
Aortic Aneurysm
Aortic Aneurysm, Abdominal
Endoleak
Female
Humans
Male
Neck
Retrospective Studies
Thrombosis

Figure

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  Fig. 1 Flow chart shows follow up result of endoleak. A. Residual endoleak. B. Newly developed endoleak.

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  Fig. 2 A 59-year-old man with abdominal discomfort. A. Abdominal aortogram shows aneurysmal dilatation of abdominal aorta, both common iliac arteries and both internal iliac arteries with tortuousity and irregularity of aortic wall. B. Coil embolization of both internal iliac arteries (black arrowheads) and stent-graft deployment is performed. Completion angiogram shows complete exclusion of aneurysm. However, after 1 week, type 1B endoleak from right limb is detected in follow up abdominal CT (not shown). So, secondary intervention is performed. C. On abdominal angiogram, large amount of type 1B endoleak (black arrowheads) due to separation of right limb of stent-graft is visible. So additional stent-graft is deployed in right limb (not shown). D. Follow up abdominal CT performed 6 months after secondary intervention, and there is no residual endoleak.

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  Fig. 3 Clinical success analysis of all patients. Clinical success comparison between hostile neck group (red) and good neck group (blue).

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  Fig. 4 A 60-year-old man with incidentally detected abdominal aortic aneurysm. Preprocedural left internal iliac artery embolization is done 7 days ago (not shown). A. Abdominal aortogram shows abdominal aortic aneurysm (diameter: 5 cm) with aneurismal dilatation of both common iliac arteries. Accessory right renal artery (white arrowhead) arises from proximal portion of abdominal aortic aneurysm. B. Selective angiogram of right renal artery and accessory right renal artery shows supplying corresponding renal parenchyma. C. For prevention of type II endoleak, coil embolization is done for accessory right renal artery (white arrowheads). Previous coil embolization of left internal iliac artery (black arrowheads) is shown. D. Follow up CT angiography shows complete exclusion of aneurysm without endoleak. Segmental renal infarction (white arrowheads) involving lower pole of right kidney is shown.

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  Fig. 5 A 73-year-old man with abdominal and back pain. A. Initial abdominal CT shows huge fusiform abdominal aortic aneurysm with intramural hematoma (white arrowheads). After 8 hours, patient complains sudden severe abdominal pain. B. On unenhanced abdominal CT, it shows large hematoma (black arrowheads) around abdominal aortic aneurysm, suggestive of ruptured abdominal aortic aneurysm. C. On abdominal aortogram, huge abdominal aortic aneurysm with hostile neck is shown. D. After embolization of right internal iliac artery (black arrowheads) with vascular plug, deployment of stent-graft is done. On completion angiogram, there is no residual endoleak. E. On follow up abdominal CT after 1 month, complete exclusion of aneurismal sac, with remained large amount of resolving hematoma (white arrowheads) in right side of abdomen is shown.

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