2022 Volume 31 Issue 5 Pages 291-297
Objectives: The aneurysmal sac shrinkage has been reported as the strong predictor of favorable long-term outcome after endovascular abdominal aortic aneurysm repair (EVAR). We evaluated the effects of perioperative and intraoperative factors on the aneurysm sac shrinkage. Methods: EVAR was performed for 296 patients during 2009.8–2021.12. nine patients with type Ia, Ib or III, 69 patients with sac diameter change less than 5 mm, and 5 patients with sac re-expansion after shrunk more than 5 mm were excluded. Thus, patients with sac shrinkage 5 mm or more (79 patients, shrinkage group) and with sac expansion 5 mm or more (18 patients) were included in this study. Antifibrinolytic therapy with tranexamic acid 1500 mg/day for 6 month after EVAR (TXA) was introduced in 2013 March and patent aortic side branches were coil embolized during EVAR since July 2015. Patients’ background and patent aortic side branches at the end of EVAR were evaluated. Results: Univariate analysis for comparison between patients with sac shrinkage and sac expansion revealed that male (82.3% vs. 55.6%, p=0.021), without antiplatelet therapy (40.5% vs. 66.7%, p=0.044) and TXA (79.8% vs. 38.9%, p<0.001) were significantly associated with sac shrinkage. By multivariate analysis, the odds ratio of sac shrinkage was 11.7 for male, 0.1 for the patients on antiplatelet therapy and 6.5 for the patient received TXA. The patients with patent inferior mesenteric artery (IMA) were less in shrinkage group (20.3% vs. 77.8%, p<0.001) and with 2 or less patent lumbar artery (LA) were more in shrinkage group (82.3% vs. 33.3%, p<0.001). The odd ratio of sac shrinkage was 7.8 for occluded IMA and 3.9 for 2 or less patent LA. Conclusion: The possibility of sac shrinkage would be high for the patient with occluded IMA and 2 or less patent LA at the end of EVAR, and received TXA after EVAR.
