Evolution of Computed Tomography Imaging the First Year after Endovascular Sealing of Infrarenal Aortic Aneurysms Using the Nellix Device.

Autor:	van den Ham LH; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands. Electronic address: lvandenham@rijnstate.nl., Ter Mors TG; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands., Boersen JT; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands., de Vries JPPM; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands., Vriens PW; Department of Vascular Surgery, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands., Heyligers JM; Department of Vascular Surgery, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands., Reijnen MMPJ; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2018 Feb; Vol. 47, pp. 223-229. Date of Electronic Publication: 2017 Sep 12.
DOI:	10.1016/j.avsg.2017.07.038
Abstrakt:	Background: The Nellix endovascular aneurysm sealing (EVAS) system is an alternative endovascular treatment option for infrarenal aortic aneurysms (AAAs), with a unique appearance on computed tomography angiography (CTA). Normal evolution of post-EVAS CTA appearance follow-up is still largely unknown and important to timely detect eventual complications. The objective is to assess the normal appearance of CTA images 30 days and 1 year after EVAS in 50 consecutive patients. Methods: Fifty patients treated with Nellix EVAS for an infrarenal AAA were included from 3 hospitals. Using dedicated software, a total of 150 CTA scans were analyzed by predetermined variables per anatomical segment. Results: Thirty days post-EVAS, there was a slight, but not statistically significant, increase in AAA diameter that returned to the preoperative value after 1 year. A shift in total aortic volume distribution was observed without changing aortic diameter, including a trend toward a decreased thrombus volume (85.6 ± 49.1 mL and 78.8 ± 35.5 mL at 30 days and 1 year, respectively, P < 0.242) and a slight, but statistically significant, increase in polymer volume (68.2 ± 34.1 mL and 71.9 ± 35.2 mL at 30 days and 1 year, respectively, P < 0.001). The β-angle (P = 0.06) and iliac artery angulation (P < 0.001) decreased after implant. The latter returned to its original state after 1 year, whereas the neck straightening remained. Over time, there was a significant decrease in radiodensity in the middle of the polymer-filled endobags with an increase at its edges (P < 0.05). Thrombus radiodensity significantly increased over the first year (P < 0.05). Diameters of the infrarenal neck and common iliac arteries remained unchanged, no endoleaks were observed, and the position of the device was stable. Conclusions: Change of CT appearance after EVAS is unique, and as such, the judgment of these images requires experience. The appearance of the endobags in respect to volume and radiodensity differ from classic EVAR. Normal changes over time are observed in aortoiliac angulation, volumes, and radiodensities. (Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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