Broda Magdalena, Rossillon Alexandre, Le Houérou Thomas, Ruppli Camille, Lorisson Erol, Al Osail Emad, Fabre Dominique, Bartoli Michel, Haulon Stéphan
Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France; Department of Vascular Surgery, Zealand University Hospital, Roskilde, Denmark; Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
Vascular Surgery Department, CHU la Timone, Marseille, France.
J Vasc Surg. 2025 Mar;81(3):623-629. doi: 10.1016/j.jvs.2024.10.070. Epub 2024 Nov 8.
Abdominal aortic aneurysm (AAA) shrinkage is considered a marker for success following endovascular aortic repair (EVAR). Although maximum diameter is widely used to assess sac behavior, research indicates that changes in AAA morphology do not always affect the maximum diameter. The aim of this study was to investigate if automated AAA sac volume measurements after EVAR can add more nuanced information on sac behavior compared with maximum diameter evaluation alone.
A retrospective review of all patients treated for AAA with a standard or fenestrated EVAR at two tertiary referral centers was performed. Patients with a preoperative and postoperative computed tomography angiography ≥2 years after treatment were included. Data were collected using medical charts, radiological institutional databases, and a deep learning based method called Augmented Reality for Vascular Aneurysm. Volume and diameter assessments were automatically performed on computed tomography angiography using Augmented Reality for Vascular Aneurysm. Preoperative sac volumes and diameters were compared with those obtained at least two years after repair. Information on endoleaks (ELs) was collected. Continuous data were tested using the t test, and categorical data were tested using the χ or Fishers test, depending on sample size.
A total of 89 patients (standard EVAR n = 46; fenestrated EVAR n = 43) were included in this study. Of the 89 patients, 41 (46%) had sac diameter shrinkage, 38 (43%) had stable sac diameters, and 10 (11%) had diameter sac growth during follow-up. The distribution of sac volume behavior was different among these patients: 51 (57%) had volume shrinkage, 9 (10%) had stable volumes, and 29 (33%) had volume growth. Significantly more patients had sac growth and fewer had sac stability, when assessed with volume compared with diameter (P = .003 and P < .001, respectively). The increase in patients with volume-assessed sac shrinkage (57% vs 46%) was not statistically significant. Of the 18 patients (20%) with stable sac diameters and simultaneous volume growth, 13 (72%) had ELs (type 2 ELs, n = 9; type 1 ELs, n = 2, type 3EL, n = 1, and EL of undefined origin, n = 1).
This study found that volume-assessed sac behavior identifies more sac shrinkage or growth, and less sac stability than diameter does. If confirmed by larger studies, sac volume assessment should be performed routinely after endovascular repair.
腹主动脉瘤（AAA）缩小被认为是血管腔内主动脉修复术（EVAR）成功的标志。尽管最大直径被广泛用于评估瘤体情况，但研究表明，AAA形态的变化并不总是影响最大直径。本研究的目的是探讨与单独的最大直径评估相比，EVAR术后自动测量AAA瘤体体积是否能提供有关瘤体情况的更细微信息。
对两家三级转诊中心接受标准或开窗EVAR治疗AAA的所有患者进行回顾性研究。纳入治疗后≥2年有术前和术后计算机断层扫描血管造影的患者。使用病历表、放射学机构数据库以及一种名为“血管动脉瘤增强现实”的深度学习方法收集数据。使用“血管动脉瘤增强现实”对计算机断层扫描血管造影自动进行体积和直径评估。将术前瘤体体积和直径与修复后至少两年时获得的结果进行比较。收集内漏（ELs）信息。连续数据使用t检验，分类数据根据样本量使用χ检验或费舍尔检验。
本研究共纳入89例患者（标准EVAR 46例；开窗EVAR 43例）。在这89例患者中，41例（46%）瘤体直径缩小，38例（43%）瘤体直径稳定，10例（11%）在随访期间瘤体直径增大。这些患者的瘤体体积变化分布不同：51例（57%）体积缩小，9例（10%）体积稳定，29例（33%）体积增大。与直径评估相比，体积评估时瘤体增大的患者显著更多，瘤体稳定的患者显著更少（分别为P = .003和P < .001）。体积评估时瘤体缩小患者增加（57%对46%）无统计学意义。在18例（20%）瘤体直径稳定且同时体积增大的患者中，13例（72%）有内漏（2型内漏9例；1型内漏2例，3型内漏1例，不明来源内漏1例）。
本研究发现，与直径评估相比，体积评估的瘤体情况能识别出更多的瘤体缩小或增大，以及更少的瘤体稳定情况。如果更大规模的研究证实，血管腔内修复术后应常规进行瘤体体积评估。
