Aortic side branch perfusion alone does not account for high intra-sac pressure after endovascular repair (EVAR) in the absence of graft-related endoleak.

Abstract

OBJECTIVE:

to examine the effect of stent-graft deployment on pressure within an aneurysm sac and to investigate the potential sources of intra-sac pressure.

MATERIAL AND METHODS:

intra-sac pressure was monitored during and immediately after endovascular repair via an indwelling catheter. Intra-sac pressure was also monitored during conventional open repair and was compared with the pressure measured within patent lumbar and inferior mesenteric side-branches, both before and after restoration of iliac arterial blood flow. Intra-sac and side-branch pressures were recorded and expressed as ratios of simultaneously measured radial artery pressure.

RESULTS:

in the absence of a graft-related endoleak (23/25 patients), endovascular repair resulted in a significant reduction in intra-sac pulse pressure (median ratio 0.31 IQR 0.10-0.46). There was no corresponding reduction in mean intra-sac pressure (median ratio 0.91; IQR 0.83-1.00). Application of clamps at conventional open repair resulted in a fall in both intra-sac pressure (median ratio 0.39, IQR 0.32-0.64) and pressure within side-branches (median ratio 0.45, IQR 0.33-0.64). Restoration of iliac blood flow resulted in a modest recovery of the side-branch pressure (median ratio 0.63, IQR 0.57-0.81), which nonetheless remained significantly less than the intra-sac pressure recorded after EVAR (p=0.01).

CONCLUSION:

reperfusion of the aneurysm sac through patent side-branches seems insufficient to account for persistent pressurisation of the aneurysm after endovascular repair. This finding supports the hypothesis that pressure may be transmitted directly through stent-graft fabric.

• Authors: S R Vallabhaneni, G L Gilling-Smith, T V How, J A Brennan, D A Gould, R G McWilliams, P L Harris
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 25 Issue 4 Pg. 354-9 (Apr 2003) ISSN: 1078-5884 [Print] England
• PMID: 12651175 (Publication Type: Clinical Trial, Journal Article)

Topics

• Aortic Aneurysm (physiopathology, surgery)
• Aortic Rupture (etiology, physiopathology)
• Blood Pressure (physiology)
• Blood Vessel Prosthesis Implantation (adverse effects)
• Catheters, Indwelling (adverse effects)
• Coronary Circulation (physiology)
• Hemodynamics (physiology)
• Humans
• Postoperative Complications
• Prosthesis Failure
• Vascular Patency (physiology)