Correlative effect between sac regression and clinical outcomes following endovascular repair in abdominal aortic aneurysm: fact or myth?

ABSTRACT

Introduction

Endovascular aneurysm repair (EVAR) has rapidly become the preferred management of abdominal aortic aneurysm (AAA). Sac regression status post-EVAR has been linked to clinical outcomes as well as the choice of EVAR device. The aim of this narrative review is to investigate the relationship between sac regression and clinical outcomes post-EVAR in AAA. Another aim is to compare sac regression achieved with the main EVAR devices.

Areas covered

We carried out a comprehensive literature search on multiple electronic databases. Sac regression was usually defined as a decrease in the sac diameter (>10 mm) over follow-up. This revealed that individuals who had sac regression post-EVAR had significantly lower mortality, and higher event-free survival rates. Further, lower rates of endoleak and reintervention were observed in patients with regressing aneurysm sacs. Sac regression patients also had significantly lower odds of rupture compared to counterparts with stable or expanded sacs. The choice of EVAR device was also shown to impact regression, with the Fenestrated Anaconda showing favorable results.

Expert opinion

Sac regression post-EVAR in AAA is an important prognostic factor as it translates to improved mortality and morbidity. Therefore, this relationship must be seriously taken into consideration during follow-up.

KEYWORDS:

• Abdominal aortic aneurysm (AAA)
• endovascular aortic repair (EVAR)
• sac regression
• clinical outcomes
• endograft
• Anaconda

Article highlights

• Sac regression after EVAR improves long-term survival and reduces mortality rates.

• Patients with sac regression have lower rates of reintervention and secondary procedures.

• Sac shrinkage following EVAR reduces the incidence of post-repair endoleak.

• Sac regression significantly lowers the risk of post-implantation rupture after EVAR.

• The Fenestrated Anaconda endograft exhibits a highly favorable postoperative profile including optimal sac regression.

Declaration of interest

D.M. Bailey is supported by the Royal Society Wolfson Research Fellowship (#WM170007). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Declaration of interest

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Data availability statement

The data presented in the study are publicly available on search engines such as PubMed (https://pubmed.ncbi.nlm.nih.gov/), Google Scholar (https://scholar.google.com/), Ovid (https://ovidsp.ovid.com/), Scopus (https://www.scopus.com/home.uri) and Embase (https://www.embase.com/), further inquiries can be directed to the corresponding author.

Additional information

Funding

This paper was not funded.