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Endovascular AAA repair: classification of aneurysm sac volumetric change using spiral computed tomographic angiography.

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

Aged, Angiography, Aortic Aneurysm, Abdominal, radiography, therapy, Blood Vessel Prosthesis Implantation, Case-Control Studies, Female, Follow-Up Studies, Humans, Male, Postoperative Complications, epidemiology, Stents, Time Factors, Tomography, X-Ray Computed, methods

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      To classify and analyze the volumetric changes seen on spiral computed tomographic angiography (CTA) following endovascular abdominal aortic aneurysm (AAA) repair. Fifty patients (46 men; mean age 71 years, range 51-83) with >1 year of imaging follow-up were retrospectively selected. The volume of the aneurysm sac was calculated on standard CT workstations to obtain plots of volume changes over time. For the purpose of this study, a 10% change in sac volume was considered significant. Over a mean 32-month follow-up, 256 CTA scans were performed; initial mean sac volume was 259 mL and initial mean AAA diameter was 6.5 cm. Six distinct patterns of volume change were recognized: group Ia (28 patients, 56%): progressive reduction in aneurysm sac volume; group Ib (3 patients, 6%): transient initial increase then same as Ia; group II (4 patients, 8%): no significant change; group IIIa (5 patients, 10%): late increase in volume; group IIIb (8 patients, 16%): progressive increase in volume; and group IV (2 patients, 4%): late reduction in volume after secondary intervention. Group III changes were associated with endoleak types I and III (p<0.0001). This classification system of spiral CTA volumetric changes features 6 patterns with recognized clinical significance and predictive value for endoleaks. Group I is the ideal outcome when the aneurysm sac shrinks and often completely disappears, while group III is associated with types I and type III endoleak and should prompt further investigation. Long-term volumetric analysis of all patients is advised.

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