SS19. Implications of Endoleaks on Aneurysm Sac Pressures Following Endovascular Repair of Elective and Ruptured Aortic Aneurysms

Article Outline

• Purpose
• Methods
• Results
• Conclusions
• Copyright

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Purpose 

To analyze the implications of endoleaks on sac pressures following endovascular aneurysm repair (EVAR) of elective and ruptured abdominal aortic aneurysms (AAA).

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Methods 

Since 2006, 480 patients underwent EVAR and simultaneous placement of the cardioMEMS Endosure® wireless pressure sensor in the excluded aneurysm sac for elective (n=455, 94%) and ruptured (n=25, 6%) AAA. Aneuryms sac pressures were measured prior and subsequent to completion of stentgraft placement, at 1 month, and every 6 months thereafter. Patients were also followed-up by CTA at 6-12 month intervals, and evaluated for the presence of endoleaks. All patients with type I endoleaks were treated at the time of diagnosis, patients with type II endoleaks at 6 months without decrease in aneurysm size were treated by coil embolization. The ratio of sac to systemic pressure was used to create a standardized pressure index for systolic pressures (SPI), diastolic pressures (DPI), mean (MPI), and pulse pressures (PPI).

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Results 

At postoperative time intervals ranging from 1 day to 24 months, in patients with No Endoleak (n=364, 76%), there were no significant differences in any of the mean pressure indexes, and all indexes decreased at 2 wks; SPI (0.09), DPI (0.2), MPI (0.12), and PPI (0.03). In patients with Type II Endoleak (n=102, 21%), there were marked elevations in all mean pressure indexes when compared to No Endoleak group. In this group, all indexes were higher than in patients without endoleak up to 6 months; SPI (0.30), DPI (0.46), MPI (0.38), and PPI (0.2). Treatment of Type II endoleaks lead to a significant reduction in these indexes; SPI (0.08), DPI (0.18), MPI (0.12), and PPI (0.02). Patients with Type I endoleaks had consistent elevation in all pressure indexes that approximated pre-exclusion aneurysm sac pressures; SPI (0.8), DPI (1.20), MPI (0.92), and PPI (0.42) and these indexes decreased significantly following treatment of the type I endoleaks. There was no difference in sac pressures in any group when comparing EVAR for elective vs. ruptured AAA.

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Conclusions 

Presence of Type I and II endoleaks can be predicted on by evaluating aneurysm sac pressures; the DPI and MPI are significantly elevated in presence of Type I and II endoleaks. Successful treatment of endoleaks can be predicted by decrease in aneurysm sac pressures.