Incidence, Diagnosis, and Management of Aneurysm Sac Expansion Following Endovascular Aneurysm Repair.

RPN Willoughby, JA Fenton, SR Pudupakkam, RA Greco, EWD Roberts 
Divisions of Vascular Surgery and Radiology, Sudbury Regional Hospital, Sudbury, ON

Between June, 2000 and March, 2007 165 patients underwent endovascular
repair of either thoracic aortic, abdominal aortic, or common iliac aneurysms
at our institution.  Patients were followed with serial CT scans and duplex
ultrasonography.  Ten of our patients (6.0%) exhibited aneurysm sac
expansion between 10 – 67 months following endovascular therapy (mean
36.2 months).  Six were associated with endoleaks (two type I, three type II,
and one type IV).  Six cases demonstrated stent-graft migration.  All 10
patients were successfully treated.  Six patients underwent redo-endovascular
stent-graft procedures, 2 patients were treated with coil embolization of
lumbar arteries, 1 patient was treated by open ligation of the inferior
mesenteric artery, and 1 patient received a hybrid open/redo-endovascular
stent-graft repair.  No patients required stent-graft explantation.  This review
highlights the importance of surveillance for endovascular patients, and
illustrates endotension may be successfully treated with a variety of
techniques.