To analyze the implications of endoleaks on sac pressures following endovascular aneurysm repair (EVAR) of elective and ruptured abdominal aortic aneurysms (AAA).
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).
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.
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.
Albany Medical College, Albany, NY
Author Disclosures: M. Mehta, CardioMEMS, WL Gore & Ass, Medtronic AVE; CardioMEMS, WL Gore & Ass, Medtronic AVE; CardioMEMS, WL Gore & Ass, Medtronic AVE; J.B. Taggert, CardioMEMS; S.P. Roddy, CardioMEMS; CardioMEMS; Y. Sternbach, CardioMEMS; P.B. Kreienberg, CardioMEMS; A. Desai, None; P.S.K. Paty, CardioMEMS; K.J. Ozsvath, CardioMEMS; B.B. Chang, CardioMEMS; D.M. Shah, CardioMEMS; R. Darling, CardioMEMS.
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