Aneurysm sac enlargement after endovascular Abdominal Aortic Aneurysm repair

The aim of this study is to give an overview of current knowledge regarding abdominal aortic aneurysm (AAA) growth after endovascular aortic aneurysm repair (EVAR) that could potentially lead to aortic rupture. A search on Pubmed was performed. A total of 705 articles were found after initial search, of which 49 were included in the final selection. Reports on the incidence of aneurysm enlargement following EVAR vary between 0.2 and 41 %. Continuous growth could lead to rupture of the aneurysm sac. There are several supposed risk factors for growth following EVAR. Endoleaks remain a hot topic as these could lead to persistent pressurization of the aneurysm sac causing growth. Various types of endoleak exist, of which each kind requires an individual treatment approach , Other risk factors for aneurysm growth include endotension and the use of EVAR outside instructions for use (IFU). Reinterventions following EVAR are common however it is unclear how frequently these are required because of aneurysm enlargement. Aneurysm enlargement after EVAR remains a subject of debate, as this could lead to aortic rupture. This emphasizes the need for life-long radiologic surveillance during follow-up. Aortic growth after EVAR is often a result of endoleak, however, in some cases no endoleak is detectable. Endoleak in combination with aortic growth > 5mm generally requires reintervention. A cause of concern is the liberal use of endovascular devices outside the IFU that may result in increased risk of AAA growth after EVAR.