Introduction: The prevalence of abdominal aortic aneurysm (AAA) is estimated to be between 4% and 7%. The major complication is the rupture of the AAA that leads to massive hemorrhage and even death. When indicated, AAA may be treated either by open or endovascular repair. This latter is less invasive and reduces hospitalisation length of stay and 30-days mortality rate. Nevertheless, it requires postoperative long-term surveillance in order to monitor the evolution of the aneurysmal sac. A lower mortality has been associated with the shrinkage of the aneurysm sac diameter after endovascular repair compared to stable or expanded sac.
Objectives: The aim of this study is to describe and analyse the different factors that influence the shrinkage of the aneurysmal sac diameter after endovascular repair.
Methods: We performed a retrospective monocentric study on 59 patients with an AAA treated by endovascular repair at the University Hospital of Lausanne in the vascular surgery department from January 2014 to July 2018. The population was divided into two groups according to the evolution of the aneurysmal sac diameter: sac stabilisation or shrinkage. Preoperative and postoperative parameters were extracted and analysed in order to identify predictive variables for the evolution of the sac diameter.
Results: Men represented the vast majority of the population (81%) with a mean age of 75 +/- 8 years. Out of the 59 patients, 25 (42%) showed a significant aneurysmal sac shrinkage (more than 5mm). Our study revealed that the aneurysmal sac shrinkage was more prone to occur in younger (mean of 73 years vs. 77 years, p=0.05*) and hypertensive patients (96% vs. 71%, p=0.017).
Other factors such as statin treatment, antihypertensive treatment and endoleaks as well as common comorbidities such as diabetes, hypercholesterolemia and renal insufficiency revealed non-significant influence.
Conclusion: A younger age and hypertension were two predictive factors associated with the shrinkage of the aneurysm sac after EVAR in our cohort.