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      Análisis volumétrico e influencia del trombo intraluminal tras la reparación endoluminal del aneurisma de aorta abdominal Translated title: Volumetric analysis and influence of intraluminal thrombus after endoluminal repair of abdominal aortic aneurysm

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          Abstract

          Resumen Objetivo: la precisión de la predicción del riesgo de rotura mediante control ultrasonográfico y angiotomografía computarizada está todavía lejos del método de diagnóstico óptimo para el aneurisma de aorta abdominal (AAA). El objetivo de este estudio es realizar un análisis volumétrico del saco aneurismático, comparar sus modificaciones con las del diámetro máximo, estudiar la evolución del volumen del trombo intraluminal (ILT) después de la reparación endovascular del AAA. Métodos: se analizaron un total de 144 AAA reparados por la EVAR electiva. Se realizó una angiotomografía en el periodo preoperatorio, 6-12 meses después de la intervención quirúrgica. Se calculó el diámetro máximo, el volumen del saco aneurismático y el volumen de la ILT en los tres momentos. Se determinó la modificación del diámetro, el volumen total y el volumen del trombo intraluminal (%). Se comparó la modificación del diámetro máximo con el volumen total de los aneurismas y entre el volumen total del aneurisma y el volumen del trombo intraluminal. Resultados: la media de los cambios en el diámetro máximo del AAA y el volumen después de la EVAR fue de -2,16 ± 8,20 mm y 84,4 ± 23,32 cc, respectivamente. Hubo un aumento en el volumen de AAA de 92,22 % y 57,34 % a los 6 y 12 meses en pacientes con endofugas (22.03 ± 19.03 cc a los 12 meses del periodo posoperatorio). La modificación media del ITL y del saco aneurismático fue de 0,59 ± 0,17 y 0,52 ± 1,8 para los pacientes con AAA presurizados y no presurizados, respectivamente (p = 0,308). Conclusión: el análisis volumétrico de los AAA reparados mediante tratamiento endovascular es una medida más preciso que la medición del diámetro máximo para determinar la expansión del saco aneurismático.

          Translated abstract

          Abstract Purpose: the accuracy of risk prediction by ultrasonic control and computerized angiotomography is still far from the optimal diagnostic method for abdominal aortic aneurysm (AAA). The objective of this study is to perform a volumetric analysis of the AAA sac to detect alterations and to follow-up the evolution of the volume of the intraluminal thrombus (ILT) and its influence on the overall evolution after the EVAR. Methods: a total of 144 AAAs repaired by elective EVAR were analyzed. An angiotomography was carried out in the preoperative period, 6-12 months after the operation. The maximum-diameter, aneurysmal sac volume, and ILT volume were calculated each time. We determined the modification of the diameter, total-volume and intraluminal-thrombus volume (%). We made a comparison between the modification of the maximum-diameter and the total-volume of the aneurysms and between the total-volume of the aneurysm and the volume of ILT. Results: the average changes in the maximum diameter of AAA and the volume after EVAR was -2.16 ± 8.20 mm and 84.4 ± 23.32 cc, respectively. There was an increase in AAA-volume of 92.22 % and 57.34 % at 6 and 12 months in patients with endoleaks (22.03 ± 19.03 cc at 12 months of postoperative-period). The means of the ILT and AAA sac ratios were respectively 0.59 ± 0.17 and 0.52 ± 1.8 in AAA in sac growth and in stable or contracted AAA sac groups (p = 0.308). Conclusion: volumetric analysis of AAA repaired by EVAR is a more sensitive measure to determine the expansion of the aneurysm sac than the measurement of the maximum diameter of the aneurysm.

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          Meta‐analysis of individual‐patient data from EVAR‐1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

          Abstract Background The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods An individual‐patient data meta‐analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm‐related mortality and reintervention. Results The analysis included 2783 patients, with 14 245 person‐years of follow‐up (median 5·5 years). Early (0–6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30‐day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm‐related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. Conclusion The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm‐related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR‐1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.
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            Intraluminal abdominal aortic aneurysm thrombus is associated with disruption of wall integrity.

            An association of intraluminal thrombus (ILT) with abdominal aortic aneurysm (AAA) growth has been suggested. Previous in vitro experiments have demonstrated that aneurysm-associated thrombus may secrete proteolytic enzymes and may develop local hypoxia that might lead to the formation of tissue-damaging reactive oxygen species. In this study, we assessed the hypothesis that ventral ILT thickness is associated with markers of proteolysis and with lipid oxidation in the underlying AAA vessel wall.
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              Comparison of volume and diameter measurement in assessing small abdominal aortic aneurysm expansion examined using computed tomographic angiography.

              First we aimed to assess the reproducibility of a computer tomography angiography (CTA) based technique for measuring infra-renal aortic volume and diameter. Second we sought to investigate whether changes in aortic volume and diameter were similar during follow-up.
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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                April 2021
                : 73
                : 2
                : 54-64
                Affiliations
                [1] Valladolid orgnameHospital Clínico Universitario de Valladolid orgdiv1Servicio de Angiología, Cirugía Vascular y Endovascular España
                [2] Valladolid orgnameFundación ASPAYM Castilla y León orgdiv1Centro de Investigación CIDIF España
                Article
                S0003-31702021000200002 S0003-3170(21)07300200002
                10.20960/angiologia.00253
                51513e8d-0c94-4982-99fe-cebbc1c589b1

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 08 January 2021
                : 22 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 29, Pages: 11
                Product

                SciELO Spain

                Categories
                Original

                Abdominal aortic aneurysm,Volumetric analysis,Endofuga,Diámetro máximo,Tratamiento endovascular,Aneurisma de aorta abdominal,Análisis volumétrico,Endoleak,Maximum diameter,Endovascular treatment

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