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. 2022 Feb 23;11(5):1203.
doi: 10.3390/jcm11051203.

Supra- and Infra-Renal Aortic Neck Diameter Increase after Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm

Claire van der Riet  1 , Richte C L Schuurmann  1 , Angelos Karelis  2   3 , Mehmet A Suludere  1 , Meike J van Harten  1 , Björn Sonesson  2   3 , Nuno V Dias  2   3 , Jean-Paul P M de Vries  1 , Martijn L Dijkstra  1
Affiliations

Supra- and Infra-Renal Aortic Neck Diameter Increase after Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm

Claire van der Riet et al. J Clin Med. .

Abstract

Hypovolemia-induced hypotension may lead to an aortic diameter decrease in patients with a ruptured abdominal aortic aneurysm (rAAA). This study investigates the changes in supra- and infra-renal aortic neck diameters before and after endovascular aortic aneurysm repair (EVAR) for rAAA and the possible association with endograft apposition. A retrospective cohort study was conducted including 74 patients treated between 2010 and 2019 in two large European vascular centers. Outer-to-outer wall diameters were measured at +40, +10, 0, −10, and −20 mm relative to the lowest renal artery baseline on the last pre- and first post-EVAR computed tomography angiography (CTA) scan in a vascular workstation. Endograft apposition was determined on the first post-EVAR CTA scan. The post-operative diameter was significantly (p < 0.001) larger than the preoperative diameter at all aortic levels. The aortic diameter at +40 mm (supra-renal) and −10 mm (infra-renal) increased by 6.2 ± 7.3% and 12.6 ± 9.8%, respectively. The aortic diameter at +40 mm increased significantly more in patients with low preoperative systolic blood pressure (<90 mmHg; p = 0.005). A shorter apposition length was associated with a higher aortic diameter increase (R = −0.255; p = 0.032). Hypovolemic-induced hypotension results in a significant decrease in the aortic diameter in patients with an rAAA, which should be taken into account when oversizing the endograft.

Keywords: abdominal aortic aneurysm; endovascular procedures; hypotension; hypovolemic shock; ruptured aneurysm.

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Conflict of interest statement

Jean-Paul P.M. de Vries and Richte C.L. Schuurmann are co-founders of Endovascular Diagnostics B.V. Other authors declare no potential conflict of interest.

Figures

Figure 1
Figure 1
Measurements in 3mensio vascular workstation on the preoperative computed tomography angiography (CTA) scan. (A) Baseline is set to the distal edge of the lowest renal artery. The end of the aortic neck is defined as the first slice that exceeds a 10% diameter increase compared with baseline; (B) positioning of three-dimensional coordinate markers. CTA coordinates are obtained from the lowest and highest renal arteries (red), the end of circumferential apposition (red), and of four radiopaque markers that define the proximal edge of the endograft fabric (green).
Figure 2
Figure 2
Diameter change at five aortic levels on the first computed tomography angiography scan after endovascular aneurysm repair.
Figure 3
Figure 3
EVAR = endovascular aneurysm repair; diameter change at various levels of the aorta relative to the renal artery baseline for patients with and without preoperative hypovolemic shock (systolic blood pressure of <90 mmHg).
See this image and copyright information in PMC

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