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Endograft Sizing for Endovascular Aortic Repair and Incidence of Endoleak Type 1A
- Source :
- PLoS ONE, PLoS ONE, Vol 11, Iss 6, p e0158042 (2016), PLoS ONE, 11(6):e0158042. PUBLIC LIBRARY SCIENCE
- Publication Year :
- 2016
- Publisher :
- Public Library of Science (PLoS), 2016.
-
Abstract
- ObjectiveIn endovascular aortic aneurysm repair (EVAR), proximal type 1A endoleaks can occur as a result of hostile neck anatomy or over- or undersizing of the endograft. As the current standard is based on the diameter or average of the short and long axes in a central lumen reconstruction image, it can falter in irregularly shaped aortic necks. An alternative method is circumference-based, therefore minimizing the measurement error. In this study we aimed to assess the degree of discrepancy between both methods and the association of this discrepancy with the occurrence of endoleak type 1A.MethodsAll patients with early (ResultsIn 482 EVAR patients, 18 early endoleak type 1A cases were found (3.9%). After exclusion, 12 cases remained and 48 matching controls were found. No significant differences were found between the two measuring methods at any level below the renal arteries. The interobserver variability was significant for the D(mean) (0.4 +/- 1.69 mm, P = .02) and was larger than the D(circ) method (-0.1 +/- 1.03 mm, P = .35). In only four out of 12 cases the endograft size was 10-20% larger than the D(mean) and D(circ) measurements. The differences between the diameter of the D(mean) and D(circ) and the chosen endograft were smaller for the case group (-8 +/- 25.6% and -7 +/- 24%) than for the control group. (-12.4 +/- 12.4% and -11 +/- 10.7%).ConclusionThe difference between the D(mean) and D(circ) methods for aortic neck measurement was not large enough to play a significant role in the incidence of endoleak type 1A. Inadequate oversizing and considerable beta-angulation of the aortic neck may have been the cause of endoleak type 1A in this population. Robust and well-investigated sizing methods are paramount for accurate endograft sizing and prevention of endoleak type 1A. Therefore the lack of studies in this field and a sizeable inter-observer variability do not justify the widespread reliance on the traditional diameter-based methods for endograft sizing.
- Subjects :
- Male
Medical Doctors
Endoleak
Physiology
Health Care Providers
medicine.medical_treatment
lcsh:Medicine
030204 cardiovascular system & hematology
Vascular Medicine
Diagnostic Radiology
VALVE-REPLACEMENT
Aortic aneurysm
Endocrinology
0302 clinical medicine
Valve replacement
Risk Factors
Medicine and Health Sciences
Medicine
030212 general & internal medicine
lcsh:Science
Tomography
Aorta
Aged, 80 and over
Observer Variation
education.field_of_study
Multidisciplinary
Radiology and Imaging
Incidence
Incidence (epidemiology)
ANEURYSM REPAIR
Arteries
ANATOMY
Aortic Aneurysm
Professions
Physical Sciences
Female
Radiology
Aneurysms
Research Article
Statistical Distributions
medicine.medical_specialty
Endocrine Disorders
Imaging Techniques
Population
Lumen (anatomy)
Neuroimaging
EUROSTAR
Research and Analysis Methods
Calcification
Blood Vessel Prosthesis Implantation
03 medical and health sciences
NECK ANGULATION
Renal Arteries
Diagnostic Medicine
Physicians
medicine.artery
Diabetes Mellitus
MANAGEMENT
Humans
Vascular Diseases
Thrombus
education
Demography
Aged
Retrospective Studies
Surgeons
business.industry
lcsh:R
Biology and Life Sciences
HOSTILE
Probability Theory
medicine.disease
Computed Axial Tomography
Health Care
Metabolic Disorders
Case-Control Studies
People and Places
Cardiovascular Anatomy
Blood Vessels
lcsh:Q
Population Groupings
Physiological Processes
business
Mathematics
Neuroscience
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- PLOS ONE
- Accession number :
- edsair.doi.dedup.....3b62cca8401aa7e9c14029dbdb884357