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Extending clinical experience of aneurysm sac pressure monitoring: from endovascular repair of abdominal aortic aneurysm to thoracic aortic aneurysm

OBJECTIVE: This study explores the clinical application of aneurysm sac pressure monitoring for TAA and assesses its utility for endoleak detection.
METHODS: 47 consecutive patients undergoing endovascular AAA and TAA repair had concurrent CardioMEMS® endosensor implantation. Sac pressure measurements were obtained intra-operatively prior to aneurysm exclusion, post-exclusion, on post-operative day 1 and 14, and at one and six month follow-up. Systolic (SSP), diastolic (DSP) and pulse (PSP) sac pressures were recorded. CT scans were obtained at anytime endoleak was suspected, and at scheduled intervals.
RESULTS: 40 AAA and 7 TAA were treated using Excluder, TAG or Zenith devices. A similar pattern of sac pressure change (p >.05) was noted during repair of AAA or TAA and follow-up. DSP elevation, SSP drop and PSP narrowing (p <.001) signaled successful sac exclusion. DSP, SSP and PSP decreased continually for up to 7 days (p <.001). Three Type I endoleaks (2 AAA and 1 TAA) were indicated by elevated DSP and SSP, pulsatile waveform with > 0.7 pulse pressure ratio during stent-deployment. There were successfully treated with proximal extension cuffs and normalized sac pressure followed. Two type II endoleaks were detected in hybrid endovascular repair of TAA on follow-up with constant elevated DSP and SSP but diminished PSP. CT scans confirmed type II endoleaks from debranched SMAs in both cases. Intervention with coil embolization caused an immediate drop in DSP and SSP.
CONCLUSIONS: A similar pattern of sac pressure change during endovascular TAA and AAA repair confirms the potential utility of the endosensor in TAA repairs. The endosensor is a sensitive monitor to predict specific type of endoleaks and its treatment outcome in both AAA and TAA repairs.