Cardiovascular Journal of Africa: Vol 27 No 1 (January/February 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016 12 AFRICA
The effect of anatomical factors on mortality rates after
endovascular aneurysm repair
Derih Ay, Burak Erdolu, Gunduz Yumun, Ahmet Demir, Ufuk Aydin, Hakan Ozkan, Kamuran Erkoc,
Osman Tiryakioglu
Abstract
Objective: The objective of this study was to investigate the
effect of anatomical characteristics on mortality rates after
endovascular aneurysm repair (EVAR).
Methods: We investigated 56 EVAR procedures for infrare-
nal aortic aneurysms performed between January 2010 and
December 2013, and the data were supplemented with a
prospective review. The patients were divided into two groups
according to the diameter of the aneurysm. Group I (n = 30):
patients with aneurysm diameters less than 6 cm, group II ( n =
26): patients with aneurysm diameters larger than 6 cm. The
pre-operative anatomical data of the aneurysms were noted and
the groups were compared with regard to postoperative results.
Results: There were no correlations between diameter of
aneurysm (p > 0.05), aneurysm neck angle (p > 0.05) and
mortality rate. The long-term mortality rate was found to be
high in patients in whom an endoleak occurred.
Conclusion: We found that aneurysm diameter did not have
an effect on postoperative mortality rates. An increased
EuroSCORE value and the development of endoleaks had an
effect on long-term mortality rates.
Keywords: abdominal aortic aneurysm, EVAR, endoleak
Submitted 16/4/15, accepted 2/7/15
Published online 14/7/15
Cardiovasc J Afr 2016; 27: 12–15
DOI: 10.5830/CVJA-2015-057
An aortic aneurysm is defined as a greater than 50% increase
in the aortic diameter compared to the normal proximal aorta.1
Large aortic aneurysms tend to enlarge and rupture eventually.
The annual risk of rupture of aneurysms with diameters larger
than 6 cm is more than 25%.2
Generally, elective surgery or endovascular repair
is recommended in aneurysms with diameters larger than
5.5 cm, whereas in those with smaller diameters, follow up
with ultrasonography or computerised tomography (CT) is
recommended.3 Endovascular repair compares favourably to
open aneurysm repair, with a significant reduction in morbidity,
reduced blood loss, shorter hospital stay, and earlier return to
normal function.4
The size of the abdominal aortic aneurysm is the major
determinant of risk of aneurysm rupture and long-term survival.5
The threshold value for differentiation of small and large
aneurysms is generally 5.5 cm. Aneurysms whose diameter is
smaller than 5.5 cm are evaluated as small aneurysms and when
they are greater than 5.5 cm, they are regarded as large aneurysms.
The treatment of AAA smaller than 5.5 cm with EVAR
requires less recurring intervention compared with large
aneurysms.6 Although early and long-term results in small
aneurysms in which EVAR was performed were better when
compared to large aneurysms, the relationship between size of
the aneurysm and results after EVAR is unclear.7
The effect of EVAR on aneurysm morphology is changing.
During or post-EVAR, it is possible that an angulated aneurysm
neck can be straightened under the influence of the guidewire,
the delivery system, and the stent-graft, and the aneurysm sac
shrinks as a result. 8
The aim of the current study was to determine the effect of
pre-operative diameter and anatomical characteristics of the
aneurysms on the outcome after EVAR. Therefore, patients with
aneurysms larger than 5.5 cm were selected for the study and
divided into two groups according to increased rupture risk (≤
6 cm vs > 6 cm).
Methods
A total of 56 patients underwent EVAR for a fusiform infrarenal
AAA between January 2010 and December 2013 at Bursa
Yuksek İhtisas Education and Research Hospital and Medical
Park Bursa Hospital. Upon pre-operative evaluation, coronary
artery disease was detected in 18 cases (32%), previous coronary
artery bypass surgery was reported in eight (14%), and peripheral
artery disease was found in eight cases (14%) (Table 1).
The patients, all of whom were symptomatic, were divided
into two groups according to the diameter of the aneurysm,
measured with abdominal CT (at its largest site): group I
included patients with an aneurysm diameter of 6 cm and below,
and group II included patients with an aneurysm diameter
larger than 6 cm. The patient data were prospectively collected.
The primary end-point criteria of the study were determined
Department of Cardiovascular Surgery, Bursa Yüksek
İhtisas Education and Research Hospital, Bursa, Turkey
Derih Ay, MD
Burak Erdolu, MD
Gunduz Yumun, MD
Ufuk Aydin, MD
Department of Cardiovascular Surgery, Yalova State
Hospital, Yalova, Turkey
Ahmet Demir, MD
Department of Cardiovascular Surgery, Bahcesehir University
Medical Faculty and Medical Park Bursa Hospital, Bursa, Turkey
Hakan Ozkan, MD
Osman Tiryakioglu, MD,
Department of Cardiovascular Surgery, Medical Park Bursa
Hospital, Bursa, Turkey
Kamuran Erkoc, MD