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The Effect Of Endograft Re-Lining On Sac Expansion After EVAR With the Original-Permeability Gore Excluder AAA Endoprosthesis

Introduction and Objectives: Endovascular abdominal aortic aneurysm repair (EVAR) with the original- permeability Gore Excluder has been associated with postoperative sac expansion in the absence of endoleak. In these cases, we have performed an endovascular revision, relining the original endograft with a low-permeability Excluder, in an effort to arrest sac expansion by reducing permeability.
Methods: Patients who demonstrated sac expansion (>5 mm diameter, >5% 3-D volume) after EVAR with the original Excluder were evaluated for etiology. If expansion appeared to be due to material permeability, they were offered a re-lining procedure.
97 patients underwent EVAR for asymptomatic AAA using the original porosity Gore endoprosthesis between 1999 and 2004. Of these, 24 patients have had sac expansion, of which 9 have had re-lining. Of the 9 with re-lining, 5 patients had no demonstrable endoleak and have >6 months follow-up. In these 5 patients, aneurysm growth was detected at 30 months (mean) by diameter criteria and 21 months (mean) by the more sensitive 3-D volume criteria. Re-lining was performed at a mean of 35 months.
Results: In all 5 patients, AAA size was stable or smaller in the first 6 months after their original EVAR (Table). During the 6 months prior to relining, however, aneurysm size increased in all five patients, despite confirming the absence of endoleak with multimodality imaging techniques (Table). After re-lining with another Excluder endoprosthesis, aneurysm growth was arrested in all patients, and AAA size even decreased (Table, P<.05).
Conclusions: Based on serial 6 month follow up intervals, it appears that AAA expansion due to permeability issues after EVAR with the original Excluder can be arrested by endovascular re-lining with an Excluder low-permeability endoprosthesis.