REDUCTION IN AORTIC-ANEURYSM SIZE - EARLY RESULTS AFTER ENDOVASCULAR GRAFT PLACEMENT

Purpose: Previous reports demonstrate initial technical success with t ransluminally placed endovascular grafts (TPEG) for the treatment of a bdominal aortic aneurysms. However, long-term changes in the size of t he aorta and aneurysmal segments are unknown. The purpose of this stud y was to determine aortic dimensions at several levels by computed tom ographic (CT) scans 1 year after TPEG. Methods: Thirty-four patients u nderwent TPEG with i-year CT scans. Patients were divided into three g roups: group I, no perigraft leak; group II, early perigraft leak that sealed during the first year; and group III, persistent perigraft lea k. Aortic minor and major diameters, perimeter, and area were measured at four locations: the celiac aorta, proximal neck, maximal aneurysm size, and distal neck. Results: There were 32 men and two women, with a mean age of 73+/-8 years. In group I there were 20 patients (58%), a nd groups II and III had seven patients (21%) each. The overall mean a neurysm minor diameter decreased from 4.79+/-0.68 cm at implantation t o 4.39+/-0.86 cm at 1 year (p <0.0001). The aneurysm sac decreased by 0.63+/-0.58 cm in group I, and by 0.34+/-0.24 cm in group II. In group III, however, the aneurysm sac increased by 0.19+/-0.21 cm. Aneurysm size change did not correlate with inferior mesenteric or lumbar arter y patency. The dimensions of the celiac aorta and proximal neck did no t change significantly. However, diameter of the distal neck enlarged by 0.12+/-0.27 cm (p <0.01). Conclusions: TPEG exclusion is associated with reduction of aneurysm size 1 year after implantation. Expansion of the aneurysms occurred with persistent perigraft leak. The aortic s ize at the celiac artery and proximal neck did not change. Dilation of the distal neck was minor but requires further long-term follow-up to determine clinical significance.