November 04, 2009

Significance of Initial Aortic Aneurysm Pressure Sensor Readings Varies With Aortic Endograft Design

Gautam V. Shrikhande, MD, Hafiz G. Hussain, MD, Alicia Menezes, John K. Karwowski, MD, Lee J. Goldstein, MD, William Gray, MD, James F. Mckinsey, MD, Harry L. Bush, Jr., MD.
New York Presbyterian Hospital/University Hospitals of Cornell and Columbia, New York, NY, USA.

Objectives
The differences in implantable pressure sensor aneurysm sac readings were compared following endovascular aneurysm repair (EVAR) among three different stent grafts.
Methods
From January 2006 to March 2009, 51 aortic stent grafts were implanted along with the Endosure sensor (CardioMEMS, Inc, Atlanta, Ga). Grafts used were Zenith (Cook, Indianapolis, Ind), Talent (Medtronic, Santa Rosa, Calif), and Excluder (WL Gore, Flagstaff, Ariz). In this retrospective study, pulse ratios were measured intraoperatively pre and post aneurysm sac exclusion and in follow up (within 30 days of the procedure). Univariate analysis of variance (ANOVA) was used to asses for statistical significance.
Results
The average aneurysm size that was repaired was 5.75 cm (range 4-8.5 cm); 41 patients (80%) being male with an average age of 76.3 (range 58-90). 34 grafts were Zenith, 9 were Talent, and 8 were Excluder. The average pre aneurysm exclusion pulse ratios for the Zenith, Talent, and Excluder were 1.00, 1.08, and 0.95 (p=0.178), respectively. The average post aneurysm exclusion pulse ratios were 0.34, 0.67, and 0.35, respectively (p=0.003). Pulse ratios at the time of follow up (within 30 days) were 0.17, 0.22, and 0.11, respectively (p=0.443). 9 of 51 (17.6%) patients had a reduction of pulse ratios of less than 30% after endograft implantation. 5 of these 9 patients (55.5%) had the Talent endograft although there was no angiographic evidence of endoleak.
Conclusion
The Talent graft has significantly higher pulse ratios following endograft implantation despite having no angiographic evidence of endoleak when compared to the Zenith and Excluder. However, the pulse ratios decreased to levels similar to Zenith and Excluder within 30 days of endograft implantation. This suggests the Talent endograft may have increased porosity initially. If pulse ratios do not appropriately decrease immediately after device implantation, further angiographic imaging may not be necessary if no obvious endoleak is seen.

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