Aneurysm Expansion after Stent-Graft Placement in the Absence of Endoleak (2023)

Cited by (21)

  • Association between Aortic Remodeling and Stent Graft-Induced New Entry in Extensive Residual Type A Dissecting Aortic Aneurysm after Hybrid Arch Repair

    2016, Annals of Vascular Surgery

    Citation Excerpt :

    However, no significant differences were found in taper ratios between patients in the SINE and non-SINE groups. Kato et al.12 suggested a more fibrotic and seemingly stable membrane for endovascular repair in the chronic phase. Our previous work13 demonstrated that endograft area oversized more than 4 times significantly increased SINE occurrence after hybrid arch elephant trunk repair using stainless steel-based devices in aortic dissection.

    This study evaluated sequential aortic morphologic remodeling and influencing factors between distal stent graft-induced new entry (SINE) in chronic residual type A dissecting aortic aneurysm after extensive hybrid arch repair.

    We retrospectively analyzed operative and follow-up data of 30 consecutive patients with chronic residual type A aortic dissection aneurysm treated by hybrid type III arch repair (ascending aortic and arch replacement combined with elephant trunk technique before stent-graft deployment) between November 2006 and October2011.

    In 3 years, follow-up of 24 patients with successful 1-stage hybrid arch repair and stent grafting. The ratio of true lumen area increased at pulmonary artery level, but minimal change was seen in the thoracic segment distal to stent graft and abdominal aorta. Late distal SINE occurred in 14 patients (SINE group). Cross-sectional area showed significant differences in distal end of pre–stenting graft oversizing ratio (SINE group 4.32 vs. non-SINE group 2.23, P=0.021). The thoracic segment thrombosis rate was 90% in SINE and 57% in non-SINE (P=0.089) groups.

    In homogenous population of chronic residual type A dissection, noticeable false lumen thrombosis with true lumen progressive dilatation was only found at the proximal descending aortic segment extending to the middle of stent grafts in both groups. A smaller size selection of the distal stent graft by area measurement would be accompanied with poor aortic remodeling but might be beneficial for SINE prevention. On the other hand, a larger size selection of the distal stent graft area might be favorable for aortic remodeling but could potentially induce SINE.

  • Gender Differences in Aortic Neck Morphology in Patients with Abdominal Aortic Aneurysms Undergoing Elective Endovascular Aneurysm Repair

    2016, Annals of Vascular Surgery

    Previous studies have demonstrated that women tend to have adverse aortic neck morphology leading to exclusion of some women from undergoing endovascular aneurysm repair (EVAR). The objective of this study is to investigate differences in aortic neck morphology in men versus women, changes in the neck morphology and sac behavior after EVAR, and investigate how these features may influence outcomes.

    We conducted a retrospective review of elective EVARs (2004–2013). We excluded patients who underwent elective EVAR with no postoperative imaging available and those patients with fenestrated repairs. Using TeraRecon and volumetric analysis, several features were investigated. These included percent thrombus, shape, length, angulation of the neck, and changes in neck and abdominal aortic aneurysm diameter.

    A total of 146 patients were found to meet inclusion criteria (115 men and 31 women) with similar baseline characteristics. Neck angulation was greater in women (23.9° vs. 13.5°; P<0.028). The percent thrombus in women was higher than men (35.4% vs. 31%; P<0.02). Abdominal aneurysm's were smaller in women at 1year (4.2cm vs. 5.1cm; P<0.002), and secondary interventions were higher in men (11.3% vs. 0%; P<0.05). Other features such as neck shape, changes in neck diameter, neck length, and percent oversizing of graft where not statistically different between genders.

    Gender differences in neck characteristics and changes in neck morphology do not appear to adversely affect EVAR outcomes. Longer follow-up is necessary to further assess whether these findings are clinically durable.

  • Basic fibroblast growth factor slow release stent graft for endovascular aortic aneurysm repair: A canine model experiment

    2008, Journal of Vascular Surgery

    (Video) NEJM Procedure: Deployment of an Endovascular Graft in an Abdominal Aortic Aneurysm

    Citation Excerpt :

    The treatment methods for endoleaks depend on the location of the leak and its type. Various methods have been reported such as glue,12 coils,15 and ligation of branches; however, these methods have shown residual endoleak.14 Surgical conversion to standard repair is the last resort for refractory endoleaks associated with expansion of the sac.

    Persistent endoleak and endotension, complications after endovascular aortic repair, may be caused by an unorganized thrombus inside the aneurysm. The experimental study was designed to evaluate the effectiveness of stent grafts (S/Gs) with slow release of basic fibroblast growth factor (bFGF) for the organization.

    The S/Gs were constructed of self-expanding Z stent covered with expanded polytetra fluoroethylene graft, and coated with elastin to be able to bind and slowly release bFGF. Five elastin-coated S/Gs with bFGF (bFGF-S/Gs) and without bFGF (C-S/Gs) were placed in the normal canine aorta respectively. The thoracic aortic aneurysm models were surgically created with a jugular vein patch in 12 beagles. S/Gs with six holes, for creating endoleaks, were used in the experiment of aneurysmal repair. The bFGF-S/Gs (n = 6) and C-S/Gs (n = 6) were implanted. The beagles were sacrificed at two weeks after the endovascular procedure and examined histologically.

    The bFGF-S/Gs induced six times the intimal proliferation of the C-S/Gs in normal aorta. Twelve animals had successfully created aneurysms, and had endoleaks just after the endovascular procedure. At two weeks after the endovascular procedure, the percentage of fibrous area in the aneurysmal cavity treated with bFGF-S/G (35.7 ± 4.3%) was significantly greater than C-S/G (13.6 ± 2.2%) (P < .01).

    bFGF-S/Gs are effective for accelerating organization of the aneurysm cavity and developing neointima. Further research on bFGF-S/Gs would clarify the association of endoleaks.

  • Reversible endotension associated with excessive warfarin anticoagulation

    2007, Journal of Vascular Surgery

    Citation Excerpt :

    This concept is supported by some operative findings where endografts have been explanted owing to endotension. In some cases, gel-like semi-liquid thrombus has been documented at proximal, distal, and junctional seal zones,12 and in others, back-bleeding has been found from lumbar vessels upon removal of this thrombus.14 It has also been noted, however, that some patients with endotension have no obvious thrombus in the intra-aneurysmal sac, but instead a clear straw-colored liquid is found.14,15

    An aortic aneurysm was successfully treated with an endovascular stent graft, with no evidence of endoleak and documented progressive aortic diameter reduction during the first 23 months. At 29 months, the patient had documented enlargement of the aneurysm sac associated with excessive anticoagulation with warfarin. No evidence of endoleak could be demonstrated with any diagnostic modality. Progressive aneurysm sac diameter regression was documented after reversal of excessive anticoagulation to therapeutic levels (international normalized ratio of 2 to 3). Strict monitoring of coagulation profile in patients after endovascular aneurysm repair requiring anticoagulation with warfarin is recommended to avoid this complication, which to our knowledge has not been previously reported.

  • Aneurysm shrinkage after endovascular repair of aortic diseases

    2006, Clinical Imaging

    There are two graft materials for endovascular repair of aortic diseases, i.e., polyester and expanded polytetrafluoroethylene (ePTFE). The latest reports have suggested that there is graft-specific difference in outcomes. The purpose of this article was to evaluate the difference in terms of aneurysm shrinkage.

    (Video) Aortic Stent Grafting

    Eighty-six patients who underwent endovascular repair of aortic diseases were included. Forty patients had true aortic aneurysms, 8 had aortic pseudoaneurysms, and 38 had aortic dissections. Eighteen patients with true aortic aneurysms were treated with stent grafts fabricated with polyester, while the other 68 patients, including 22 patients with true aneurysms, 8 patients with pseudoaneurysms, and 38 patients with aortic dissections, were treated with stent grafts fabricated with ePTFE. All patients were followed-up by computed tomography (CT) for more than 1 year. The mean follow-up term was 28 months. Computed tomography confirmed that there were sufficiently long necks, and the aneurysm or the entry tear was completely excluded without any endoleak in all patients. The diameter of the preoperative lesion was compared with that measured on follow-up CT at 1 year and at the end of the follow-up term. Increase or decrease in the diameter by more than 5 mm was defined as a significant diameter change.

    Aneurysm shrinkage was observed in 40% of patients with true aneurysms, 88% of patients with pseudoaneurysms, and 55% of patients with aortic dissections at 1 year. There was no significant increase in patients with aneurysm shrinkage at the end of follow-up in any groups. In the case of true aortic aneurysms, shrinkage of aneurysms was observed more frequently with polyester-fabricated stent grafts (67%, 13/18) than with ePTFE-fabricated ones (18%, 4/22) at 1 year (P<.01). In contrast, expansion of aneurysms was observed only in patients treated with ePTFE (14%, 3/22). Shrinkage of the descending aorta was observed in 55% of patients with acute aortic dissections and 36% of patients with chronic aortic dissections. There was no case with aortic enlargement in either group. There was no significant difference between acute and chronic dissection in terms of shrinkage of the descending aorta.

    Expanded polytetrafluoroethylene appears to be effective for the treatment of pseudoaneurysms and aortic dissections. However, polyester seems to be more effective than ePTFE when true aneurysms are to be treated.

  • Endoleak and endotension following open abdominal aortic aneurysm repair: A report of two cases

    2005, Annals of Vascular Surgery

    Anastomotic leaks and perigraft seroma are uncommon complications following open repair of abdominal aortic aneurysms; in particular, it is rare for them to cause recurrence and expansion of the aneurysm sac. We report a case of anastomotic leak presenting as type 1 endoleak and another of perigraft seroma causing recurrent pressurization, endotension, and expansion of the original aneurysm sac.

View all citing articles on Scopus

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Copyright © 2002 Society of Interventional Radiology. Published by Elsevier Inc. All rights reserved.

(Video) New and Emerging Devices to Treat Abdominal Aortic Aneurysms


What are Endoleaks after stent grafting? ›

Normally after aneurysm repair, your blood flows through a new artery lining called a stent graft. The stent graft prevents blood from flowing into the damaged part of your artery (the aneurysm sac). Blood shouldn't flow outside of your stent graft within the aneurysm sac. If that happens, it's called an endoleak.

What is an aneurysm endoleak? ›

An endoleak happens when blood finds a way around the stent graft and into the aneurysm. An endoleak can be life-threatening without treatment. You won't know you have an endoleak unless it's found during one of your checkups. But if it causes your aneurysm to tear, it's an emergency.

What happens to aneurysm after stent? ›

A flow-diverter mesh stent is placed inside the artery to reduce blood flow from entering the aneurysm. The aneurysm will eventually clot off and shrink.

What are the complications of aortic stent graft? ›

Other complications associated with endovascular stent grafting include:
  • Blood leakages around the stent graft.
  • Blockage of the flow of blood through the stent graft.
  • Movement of the stent graft from its original site of placement.
  • Fracture of the stent graft.
  • Infection.
  • Rupture of the aneurysm or aorta.


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2. Management of Endoleaks After Endovascular Aortic Repair
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3. Complications of Endovascular Stent Graft Repair
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4. The Mount Sinai Surgical Film Atlas: Endovascular Repair of an Abdominal Aortic Aneurysm
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5. Thoracic Endovascular Repair of Contained Rupture Descending Thoracic Aorta (Bavare, MD, Zubair, MD)
(Houston Methodist DeBakey CV Education)
6. Contemporary Treatment of Aneurysm of the Ascending Aorta and Arch
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