MEHMET ALİ TURKCU, OSMAN EREN KARPUZOGLU, BAHADİR AYTEKİN, FERİT CETİNKAYA, MUSTAFA DAGLİ, HAKKİ ZAFER ISCAN
Turkish Journal of Vascular Surgery - 2024;33(2):78-83
Aim: We examined the impact of preoperative three-dimensional aortic volume on outcomes following Endovascular Aortic Repair (EVAR). Material and Methods: A total of 146 patients who underwent elective EVAR at our hospital between January 2018 and January 2023, and who had preoperative and postoperative multislice Computed Tomographic Angiography (CTA), were included in the study. The effects of aneurysm sac volumetric measurements on post-EVAR endoleak, reintervention, and late mortality were evaluated. Since there is no definite cut-off value for aneurysm volume and EVAR results in the literature, we compared patients with aneurysm volumes above and below 231.7 cm³ obtained by roc analysis. Results: During the follow-up period, the rate of secondary intervention was higher if the preoperative aneurysm volume was greater than 231.7 cm³ (p=0.001) or if the preoperative thrombus volume was greater than 206.1 cm³ (p=0.002). There was no notable difference in terms of endoleak (p=0.5) and during follow-up mortality rate (p=0.8) between patients with sac volumes above and below 231.7 cm³. After EVAR, when morphological changes were examined, it was noted that there was a dilatation of the neck (preoperative 23±4 mm and postoperative 26±4 mm) (p<0.001) and a decrease in neck (infrarenal) angulation (preoperative 39 degrees and postoperative 31.5 degrees) (p<0.001). Conclusion: This study demonstrates that aneurysms with high volume are prone to secondary intervention. However, it is not correlated with early or midterm mortality and outcomes. Volumetric analysis of the aneurysms preoperatively may be an indicator of surveillance protocols and treatment choices. Lifetime follow-up and volumetric analysis of aneurysms seem crucial for effective and reliable surveillance.
