The Modification of the Follow-up Protocol in Patients after Endovascular
Abdominal Aortic Aneurysm Treatment on the Basis of Retrospective Analysis
of the Aneurysmal Sac Size Evolution and Endoleak Appearance
Černá M.1, Köcher M.2, Utíkal P.3, Benýšek V.1, Bučil J.1, Heřman M.1,Bachleda P.3, Koutná J.4
Radiologická klinika FN, Olomouc1 přednosta doc. MUDr. M. Heřman, PhD. Klinika radiologie 3. LF UK, Praha2 přednosta doc. MUDr. M. Köcher, PhD. II. chirurgická klinika FN, Olomouc3 přednosta prof. MUDr. M. Duda, DrSc. Klinika anestezie a resuscitace FN, Olomouc4 přednosta MUDr. O. Marek, CSc. |
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Summary:
Purpose: To evaluate the real value and the expediency of the follow-up protocol on the
basis of retrospective analysis of the aneurysmal sac size evolution and frequency and
type of endoleak.
Materials and Methods: A total of 131 patients with abdominal aorta aneurysm (AAA)
underwent endovascular treatment with Ella stentgraft system between April 1996
and April 2003. Ninety three patients (20 women and 73 men, median age 70 years, ranradiologie ge from 51 to 89 years) were followed-up at least one year after treatment. The followup
protocol included angiography at the fifth postoperative day and CT and US at 3, 6
and 12 months after the procedure and yearly thereafter. An abdominal X-ray was performed
yearly. The follow-up time was 1 year in 93 patients, 2 years in 75 patients, 3
years in 57 patients, 4 years in 35 patients, 5 years in 14 patients, 6 years in 9 patients,
7 years in 3 patients and 8 years in one patient. Change in sac size of 5 mm and more
was considered significant.
Results: Shrinkage of the aneurysmal sac size was found in 49.4 % of patients after one
year, in 60 % after 2 years, in 68.4 % after 3 years, in 68.6 % after 4 years, in 64.3 % after
5 years, in 55.5 % after 6 years, in 100 % after 7 and 8 years. Enlargement of aneurysmal
sac was found in 3.2 % of patients after 1 year, in 8 % in 2 years, in 12.3 % after 3
years, in 11.4 % after 4 years, in 14.3 % after 5 years, in 22.2 % after 6 years. Eight type
II endoleaks were detected during the first postoperative year after treatment, 2 endoleaks
type II during the third postoperative year. An aneurysmal sac enlargement was
found only in two of patients with endoleak type II. One type Ia endoleak was detected
during the second postoperative year, surgical conversion was performed. No aneurysmal
sac rupture was found.
Conclusion: With regard to the development of the aneurysmal sac size, frequency and
type of endoleaks, the first follow-up CT after 12 months is acceptable.
Key words:
aneurysm of abdominal aorta – endovascular treatment, sac size – followup
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