Endograft Apposition and Infrarenal Neck Enlargement after Endovascular Aortic Aneurysm Repair

Introduction: Sufficient apposition and oversizing of the endograft are not regularly stated on post-EVAR (CTA) scan reports. In this study endograft apposition and neck enlargement (NE) after EVAR with an Endurant II(s) were analyzed and associated with supra- and infrarenal aortic neck morphology.

Method(s): NE, defined as the aortic diameter change between pre- and post-EVAR CTA scan, was determined at eight levels: +40, +30, +20, +15, +10, 0, −5, and −10 mm relative to the lowest renal artery baseline. The aortic neck diameter and preoperative oversizing were correlated to NE with the Pearson correlation coefficient. The effective post-EVAR endograft oversizing is calculated from the nominal endograft diameter and the post-EVAR neck diameter where the endograft is circumferentially apposed.

Result(s): Significant (p < 0.001) neck enlargement of 1.7 (0.9, 2.5) mm was observed 5 mm below the renal artery baseline, which resulted in an effective post-EVAR endograft oversizing <10% in 43% of the patients. No correlation was found between NE and aortic neck diameter or preoperative oversizing.

Conclusion(s): Patients with SAL <10 mm or effective oversizing <10% due to NE may benefit from intensified follow-up, but clinical consequences of SAL and NE should be evaluated in future longitudinal studies.

Publication History

Article published online:
09 February 2023