Volume regression of XXXX and its relation to successful endoluminal exclusion.

@entity1 @entity1070 @entity2478 @entity887 @entity439 @entity397 @entity164 @entity16732 @entity204 @entity1028
OBJECTIVES: Evaluating the success of endoluminal repair of @entity1028 ( @entity1028 ) is frequently based on diameter measurements and determining the presence of @entity1070 . The use of three-dimensional volumetric data and observation of morphologic changes in the @entity439 and device have been proposed to be more appropriate for postdeployment surveillance. The purpose of this study was to analyze the long-term volumetric and morphologic data of 161 @entity1 who underwent endovascular AAA exclusion and to assess the utility of volume measurements for determining successful AAA repair. METHODS: @entity1 with spiral computed tomography scans obtained preoperatively, within the first postoperative month, at 6 months, and annually thereafter, were included in this analysis. Computerized interactive three-dimensional reconstruction of each AAA scan was performed. Total @entity439 sac volume was measured at each time interval (mean preoperative volume 169.0 +/- 78.5 mL), and the significance of volume changes was determined by mixed linear modeling, a form of repeated measures analysis, to account for longitudinal data clustered at the individual level. Sixty-two @entity1 (38%) developed @entity1070 at some time during follow-up-15 type I leaks, 45 @entity2478 , and 2 type III leaks. The @entity1 with @entity164 were treated with cuffs, and the @entity2478 were treated either with observation, @entity887 , or required open conversion. RESULTS: Aneurysm sac volume increased slightly at 1-month follow-up (+3.3%), and then decreased steadily to -12.9% at 5 years (P <.0001). This effect remained unchanged after controlling for the three device types used in our study population. @entity1 who did not exhibit an endoleak (n = 99) showed a significant decrease in @entity439 volume across the entire follow-up duration when compared with those who did exhibit an endoleak (n = 62) (P <.0001). The presence of a 10% or greater decrease in volume at 6 months demonstrated a sensitivity of 64%, a specificity of 95%, a positive predictive value of 95%, a negative predictive value of 62%, and an accuracy of 75% for predicting primary clinical success defined by successful deployment of the device; freedom from @entity439 - or procedure-related @entity204 ; freedom from endoleak, @entity397 , @entity16732 ; or conversion to open repair. CONCLUSIONS: Volumetric analysis may be used to predict successful endoluminal exclusion of @entity1028 . Volume regression appears to be device-independent and should be expected in most clinically successful cases. The presence of volume increases in the first 6 months is suspicious for an endoleak that is pressurizing the @entity439 sac and heralds the need for closer evaluation and possible intervention. A volume decrease of 10% or greater at 6 months and continuing regression over time is associated with successful endovascular repair.
