Purpose: Shrinkage of an abdominal aortic aneurysm (AAA) is the hallmark of
successful endoluminal treatment. Our goal was to prospectively assess the
midterm to longterm shrinkage of the AAA sac after endovascular repair.
Methods: A total of 123 patients with AAA underwent endoluminal treatment w
ith the Ancure device at our institution between February 1996 and February
2000. At least a 1-year follow-up was available for 70 of the 123 patients
. AAA sac size, presence of endoleaks, calcifications, and outcome data wer
e collected on these patients at 6, 12, 24, and 36 months after repair and
compared with the preoperative AAA size and characteristics. ALL endoleaks
found at the 6-month follow-up visit were treated aggressively with embolot
herapy. An AAA sac regression of 0.5 cm or more was considered the minimum
measurable decrease. Regression of the sac diameter to 3.5 cm or less was c
onsidered a complete collapse of the sac.
Results: Successful endoluminal repair was accomplished in 119 of 123 patie
nts. The mortality rate was 0.8% (1/123). There was a steady decrease in AA
A sac size from baseline (5.56 +/- 0.1 cm), to 6 months (5.0 +/- 0.14 cm, P
= .0006), to 12 months (4.65 +/- 0.13 cm, P = .04), and to 24 months (4.26
+/- 0.16 cm, P = .03). At 24 months, 74% (29/39) had a decrease in sac siz
e of 0.5 cm or more, with 28% (11/39) complete collapse. Patients with init
ial endoleaks had the same likelihood of regression of sac size (greater th
an or equal to 0.5 cm) when compared with the group of patients with no end
oleaks at the 24-month evaluation (64% vs 76%, P = .09).
Conclusion: Endoluminal AAA repair resulted in a significant reduction in s
ac size that continues up to 2 years. Significant shrinkage occurs as early
as 6 months after place ment. The initial presence of endoleaks does not p
redict the lack of sac regression.