Mária Rašiová, Martin Koščo, Viera Habalová, Jozef Židzik, Eva Slabá, Matej Moščovič, Ľudmila Farkašová, Ivan Tkáč
Background: Optimal treatment result after endovascular aortic aneurysm repair (EVAR) is followed by significant
aneurysm sac regression without endoleak. The aim of our study was to evaluate diameter of abdominal aneurym
sac 24 months post-EVAR; to identify factors associated with sac regression and to determine the impact of sac regression
on all-cause mortality during long-term follow-up.
Methods: We retrospectively analyzed data of patients with infrarenal abdominal aortic aneurysm (AAA) treated
between January, 2010 and July, 2016. Sac diameter pre- and 24 months post-EVAR was determined by CT-angiography
at the site of maximum axial diameter. Sac regression was defined as at least 5 mm decrease in the sac
diameter in relation to the preprocedural diameter.
Results: Over the study period, 124 patients (116 men and 8 women) with mean age 71.2 ± 7.2 years were evaluated.
Sac regression was found in 45.2% of patients. Pacient with sac regression were older (73.0 vs 69.7 years in
patients with stable sac or sac expansion; p = 0.008) with significantly higher preprocedural fibrinogen levels (3.84
vs 3.47 g/l in patients with stable sac or sac expansion; p = 0.028). Persistent type II endoleak was inversely associated
with sac regression in univariate analysis and multivariate analysis after adjustment for hypertension, sex,
smoking and dyslipidaemia (OR 0.28; 95 % CI 0.11 – 0.70; p = 0.006). In other tested factors no correlation with
sac regression was found. During long-term follow-up, no difference was found in all-cause mortality between patients
with and without sac regression.
Conclusion: Higher preprocedural fibrinogen levels, older age and absence of persistent type II endoleak were
aneurysm sac regression predictive factors. No difference was found in long-term survival between groups of patients
with sac regression and without.