Cardiovascular Journal of Africa: Vol 32 No 4 (JULY/AUGUST 2021)

10 / 61

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 4, July/August 2021 182 AFRICA
Assessing volumetric changes in abdominal aortic
aneurysms following endovascular repair
Yalçın Gunerhan, Mehmet Isik, Yüksel Dereli, Omer Tanyeli, Cengiz Kadıyoran, Mehmet Sinan Iyisoy,
Niyazi Gormus
Abstract
Objective: Volumetric changes in the aneurysm sac were eval-
uated following endovascular aortic repair (EVAR) in intact
abdominal aortic aneurysm (AAA) patients who underwent
EVAR.
Methods: Fifty-two patients, who underwent EVAR from 2015
to 2019, were analysed retrospectively. A total of 158 comput-
ed tomography angiography scans was examined by perform-
ing reconsctructive volumetric calculations. Total aneurysm
volume (TAV), patent lumen volume (PLV) and thrombus-
coated aneurysm wall volume (TCAWV) were calculated. The
results obtained at six, 12 and 24 months postoperatively were
compared with those of the pre-operative period.
Results: Mean TAV had regressed 7% by the sixth month (p =
0.1), 27% by the 12th month (p = 0.0003) and 19% by the 24th
month (p = 0.0008). Mean TCAWV had increased 2% by the
sixth month (p = 0.3), and regressed 26% by the 12th month
( p = 0.3) and 14% by the 24th month ( p = 0.8). Mean PLV
had regressed by 20% by the sixth month (p = 0.008), 29% by
the 12th month (p = 0.0002) and 26% by the 24th month (p
= 0.0006). For each individual proximal, middle and distal
measurement, regression was observed at six and 12 months;
however, an increase was observed at 24 months compared to
the previous follow ups.
Conclusion: The expansion measurements of TAV in the 24th
month support the doubts on the medium- to long-term results
of EVAR. The largest regression in the aneurysm sac was
observed in the distal portion, then in the proximal portion,
and the least regression was observed in the middle section.
Keywords: endovascular aneurysm repair, abdominal aortic
aneurysm, volumetric measurement, endotension, endoleak
Submitted 28/12/20, accepted 11/2/21
Published online 16/3/21
Cardiovasc J Afr 2021; 32: 182–187
DOI: 10.5830/CVJA-2021-005
Nowadays, endovascular aortic aneurysm repair (EVAR) is
a common method for the treatment of abdominal aortic
aneursym (AAA). Lifelong follow up is neccessary for EVAR
patients since the aneurysm diameter may increase or an
endoleak may develop over time. Changes in aneursym volume
are also critically important as they indicate the long-term
success of EVAR. 1 Computed tomography angiography (CTA)
is commonly used for patient follow up. The status of stent
grafts and aneursyms can be evaluated through observing
two-dimensional axial sections or three-dimensional volumetric
measurements of CTA scans.
Reconstructive volumetric measurement is the process of
combining two-dimensional axial sections taken from different
reference levels, converting these sections into a three-dimensional
image and obtaining volumetric measurements from the newly
formed three-dimensional image. Volumetric measurements are
considered to be more reliable than measurements obtained from
two-dimensional diameter changes.1,2
In this study, volumetric changes in the aneursym sac
following EVAR were examined in AAA patients. The aim was
to investigate to what extent an expected volumetric regression
occurred following EVAR, when expansion occurred again,
whether the stent graft placed in the patient’s lumen changed
over time, and in which part of the aneurysm sac the process
was more effective.
Methods
In this study, 132 intact infrarenal AAA patients, who had
elective EVAR surgery between November 2015 and May 2019
in our clinic, were retrospectively analysed. Fifty-two patients
who had had EVAR and CTA scans performed in the sixth, 12th
and 24th months postoperatively were included in the study.
Retrospective information of the patients was obtained from the
hospital software system.
The local ethics committee (2019/1946) approved the study
and all patients provided their written informed consent. The
study was performed in accordance with the principles of the
Helsinki Declaration.
EVAR was performed on patients whose infrarenal aortic
diameter was 5.5 cm or more. Patients who had CTA imaging
in the postoperative sixth, 12th and 24th months were included
in the study. Exlucision criteria were as follows: emergency
surgery due to AAA rupture or dissection, and renal function
impairment preventing CTA scans in routine control follow ups
Department of Cardiovascular Surgery, Harakani State
Hospital, Kars, Turkey
Yalçın Gunerhan, MD
Department of Cardiovascular Surgery, Meram Faculty of
Medicine, Necmettin Erbakan University, Konya, Turkey
Mehmet Isik, MD,
Yüksel Dereli, MD
Omer Tanyeli, MD
Niyazi Gormus, MD
Department of Radiology, Meram Faculty of Medicine,
Necmettin Erbakan University, Konya, Turkey
Cengiz Kadıyoran, MD
Department of Medical Education and Informatics, Meram
Faculty of Medicine, Necmettin Erbakan University, Konya,
Turkey
Mehmet Sinan Iyisoy, MSc