Predicting aneurysm enlargement in patients with persistent type II endoleaks

Carlos H. Timaran, Takao Ohki, Soo J. Rhee, Frank J. Veith, Nicholas J. Gargiulo, Hisako Toriumi, Mahmood B. Malas, William D. Suggs, Reese A. Wain, Evan C. Lipsitz

Research output: Contribution to journalArticle

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Abstract

Objective The clinical significance of type II endoleaks is not well understood. Some evidence, however, indicates that some type II endoleaks might result in aneurysm enlargement and rupture. To identify factors that might contribute to aneurysm expansion, we analyzed the influence of several variables on aneurysm growth in patients with persistent type II endoleaks after endovascular aortic aneurysm repair (EVAR). Methods In a series of 348 EVARs performed during a 10-year period, 32 patients (9.2%) developed type II endoleaks that persisted for more than 6 months. Variables analyzed included those defined by the reporting standards for EVAR (SVS/AAVS) as well as other endoleak characteristics. Univariate, receiver operating characteristic curve, and Cox regression analyses were used to determine the association between variables and aneurysm enlargement. Results The median follow-up period was 26.5 months (range, 6-88 months). Thirteen patients (41%) had aneurysm enlargement by 5 mm or more (median increase in diameter, 10 mm), whereas 19 (59%) had stable or shrinking aneurysm diameter. Univariate and Cox regression analyses identified the maximum diameter of the endoleak cavity, ie, the size of the nidus as defined on contrast computed tomography scan, as a significant predictor for aneurysm enlargement (relative risk, 1.12; 95% confidence interval, 1.04-1.19; P = .001). The median size of the nidus was 23 mm (range, 13-40 mm) in patients with aneurysm enlargement and 8 mm (range, 5-25 mm) in those without expansion (Mann-Whitney U test, P < .001). Moreover, receiver operating characteristic curve and Cox regression analyses showed that a maximum nidus diameter greater than 15 mm was particularly associated with an increased risk of aneurysm enlargement (relative risk, 11.1; 95% confidence interval, 1.4-85.8; P = .02). Other risk factors including gender, smoking history, hypertension, need of anticoagulation, aneurysm diameter, type of endograft used, and number or type of collateral vessels were not significant predictors of aneurysm enlargement. Conclusions In patients with persistent type II endoleaks after EVAR, the maximum diameter of the endoleak cavity or nidus is an important predictor of aneurysm growth and might indicate the need for more aggressive surveillance as well as earlier treatment.

Original languageEnglish (US)
Pages (from-to)1157-1162
Number of pages6
JournalJournal of Vascular Surgery
Volume39
Issue number6
DOIs
StatePublished - Jun 2004

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Endoleak
Aneurysm
Aortic Aneurysm
Regression Analysis
ROC Curve
Confidence Intervals
Growth
Nonparametric Statistics
Rupture

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Timaran, C. H., Ohki, T., Rhee, S. J., Veith, F. J., Gargiulo, N. J., Toriumi, H., ... Lipsitz, E. C. (2004). Predicting aneurysm enlargement in patients with persistent type II endoleaks. Journal of Vascular Surgery, 39(6), 1157-1162. https://doi.org/10.1016/j.jvs.2003.12.033

Predicting aneurysm enlargement in patients with persistent type II endoleaks. / Timaran, Carlos H.; Ohki, Takao; Rhee, Soo J.; Veith, Frank J.; Gargiulo, Nicholas J.; Toriumi, Hisako; Malas, Mahmood B.; Suggs, William D.; Wain, Reese A.; Lipsitz, Evan C.

In: Journal of Vascular Surgery, Vol. 39, No. 6, 06.2004, p. 1157-1162.

Research output: Contribution to journalArticle

Timaran, CH, Ohki, T, Rhee, SJ, Veith, FJ, Gargiulo, NJ, Toriumi, H, Malas, MB, Suggs, WD, Wain, RA & Lipsitz, EC 2004, 'Predicting aneurysm enlargement in patients with persistent type II endoleaks', Journal of Vascular Surgery, vol. 39, no. 6, pp. 1157-1162. https://doi.org/10.1016/j.jvs.2003.12.033
Timaran CH, Ohki T, Rhee SJ, Veith FJ, Gargiulo NJ, Toriumi H et al. Predicting aneurysm enlargement in patients with persistent type II endoleaks. Journal of Vascular Surgery. 2004 Jun;39(6):1157-1162. https://doi.org/10.1016/j.jvs.2003.12.033
Timaran, Carlos H. ; Ohki, Takao ; Rhee, Soo J. ; Veith, Frank J. ; Gargiulo, Nicholas J. ; Toriumi, Hisako ; Malas, Mahmood B. ; Suggs, William D. ; Wain, Reese A. ; Lipsitz, Evan C. / Predicting aneurysm enlargement in patients with persistent type II endoleaks. In: Journal of Vascular Surgery. 2004 ; Vol. 39, No. 6. pp. 1157-1162.
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abstract = "Objective The clinical significance of type II endoleaks is not well understood. Some evidence, however, indicates that some type II endoleaks might result in aneurysm enlargement and rupture. To identify factors that might contribute to aneurysm expansion, we analyzed the influence of several variables on aneurysm growth in patients with persistent type II endoleaks after endovascular aortic aneurysm repair (EVAR). Methods In a series of 348 EVARs performed during a 10-year period, 32 patients (9.2{\%}) developed type II endoleaks that persisted for more than 6 months. Variables analyzed included those defined by the reporting standards for EVAR (SVS/AAVS) as well as other endoleak characteristics. Univariate, receiver operating characteristic curve, and Cox regression analyses were used to determine the association between variables and aneurysm enlargement. Results The median follow-up period was 26.5 months (range, 6-88 months). Thirteen patients (41{\%}) had aneurysm enlargement by 5 mm or more (median increase in diameter, 10 mm), whereas 19 (59{\%}) had stable or shrinking aneurysm diameter. Univariate and Cox regression analyses identified the maximum diameter of the endoleak cavity, ie, the size of the nidus as defined on contrast computed tomography scan, as a significant predictor for aneurysm enlargement (relative risk, 1.12; 95{\%} confidence interval, 1.04-1.19; P = .001). The median size of the nidus was 23 mm (range, 13-40 mm) in patients with aneurysm enlargement and 8 mm (range, 5-25 mm) in those without expansion (Mann-Whitney U test, P < .001). Moreover, receiver operating characteristic curve and Cox regression analyses showed that a maximum nidus diameter greater than 15 mm was particularly associated with an increased risk of aneurysm enlargement (relative risk, 11.1; 95{\%} confidence interval, 1.4-85.8; P = .02). Other risk factors including gender, smoking history, hypertension, need of anticoagulation, aneurysm diameter, type of endograft used, and number or type of collateral vessels were not significant predictors of aneurysm enlargement. Conclusions In patients with persistent type II endoleaks after EVAR, the maximum diameter of the endoleak cavity or nidus is an important predictor of aneurysm growth and might indicate the need for more aggressive surveillance as well as earlier treatment.",
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AU - Timaran, Carlos H.

AU - Ohki, Takao

AU - Rhee, Soo J.

AU - Veith, Frank J.

AU - Gargiulo, Nicholas J.

AU - Toriumi, Hisako

AU - Malas, Mahmood B.

AU - Suggs, William D.

AU - Wain, Reese A.

AU - Lipsitz, Evan C.

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N2 - Objective The clinical significance of type II endoleaks is not well understood. Some evidence, however, indicates that some type II endoleaks might result in aneurysm enlargement and rupture. To identify factors that might contribute to aneurysm expansion, we analyzed the influence of several variables on aneurysm growth in patients with persistent type II endoleaks after endovascular aortic aneurysm repair (EVAR). Methods In a series of 348 EVARs performed during a 10-year period, 32 patients (9.2%) developed type II endoleaks that persisted for more than 6 months. Variables analyzed included those defined by the reporting standards for EVAR (SVS/AAVS) as well as other endoleak characteristics. Univariate, receiver operating characteristic curve, and Cox regression analyses were used to determine the association between variables and aneurysm enlargement. Results The median follow-up period was 26.5 months (range, 6-88 months). Thirteen patients (41%) had aneurysm enlargement by 5 mm or more (median increase in diameter, 10 mm), whereas 19 (59%) had stable or shrinking aneurysm diameter. Univariate and Cox regression analyses identified the maximum diameter of the endoleak cavity, ie, the size of the nidus as defined on contrast computed tomography scan, as a significant predictor for aneurysm enlargement (relative risk, 1.12; 95% confidence interval, 1.04-1.19; P = .001). The median size of the nidus was 23 mm (range, 13-40 mm) in patients with aneurysm enlargement and 8 mm (range, 5-25 mm) in those without expansion (Mann-Whitney U test, P < .001). Moreover, receiver operating characteristic curve and Cox regression analyses showed that a maximum nidus diameter greater than 15 mm was particularly associated with an increased risk of aneurysm enlargement (relative risk, 11.1; 95% confidence interval, 1.4-85.8; P = .02). Other risk factors including gender, smoking history, hypertension, need of anticoagulation, aneurysm diameter, type of endograft used, and number or type of collateral vessels were not significant predictors of aneurysm enlargement. Conclusions In patients with persistent type II endoleaks after EVAR, the maximum diameter of the endoleak cavity or nidus is an important predictor of aneurysm growth and might indicate the need for more aggressive surveillance as well as earlier treatment.

AB - Objective The clinical significance of type II endoleaks is not well understood. Some evidence, however, indicates that some type II endoleaks might result in aneurysm enlargement and rupture. To identify factors that might contribute to aneurysm expansion, we analyzed the influence of several variables on aneurysm growth in patients with persistent type II endoleaks after endovascular aortic aneurysm repair (EVAR). Methods In a series of 348 EVARs performed during a 10-year period, 32 patients (9.2%) developed type II endoleaks that persisted for more than 6 months. Variables analyzed included those defined by the reporting standards for EVAR (SVS/AAVS) as well as other endoleak characteristics. Univariate, receiver operating characteristic curve, and Cox regression analyses were used to determine the association between variables and aneurysm enlargement. Results The median follow-up period was 26.5 months (range, 6-88 months). Thirteen patients (41%) had aneurysm enlargement by 5 mm or more (median increase in diameter, 10 mm), whereas 19 (59%) had stable or shrinking aneurysm diameter. Univariate and Cox regression analyses identified the maximum diameter of the endoleak cavity, ie, the size of the nidus as defined on contrast computed tomography scan, as a significant predictor for aneurysm enlargement (relative risk, 1.12; 95% confidence interval, 1.04-1.19; P = .001). The median size of the nidus was 23 mm (range, 13-40 mm) in patients with aneurysm enlargement and 8 mm (range, 5-25 mm) in those without expansion (Mann-Whitney U test, P < .001). Moreover, receiver operating characteristic curve and Cox regression analyses showed that a maximum nidus diameter greater than 15 mm was particularly associated with an increased risk of aneurysm enlargement (relative risk, 11.1; 95% confidence interval, 1.4-85.8; P = .02). Other risk factors including gender, smoking history, hypertension, need of anticoagulation, aneurysm diameter, type of endograft used, and number or type of collateral vessels were not significant predictors of aneurysm enlargement. Conclusions In patients with persistent type II endoleaks after EVAR, the maximum diameter of the endoleak cavity or nidus is an important predictor of aneurysm growth and might indicate the need for more aggressive surveillance as well as earlier treatment.

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