Potential Value of Aneurysm Sac Volume Measurements in Addition to Diameter Measurements after Endovascular Aneurysm Repair

Purpose: To investigate the value of aneurysm sac volume measurement in addition to diameter measurements based on computed tomographic angiography (CTA) after endovascular aneurysm repair (EVAR). Methods: Interrogation of a vascular database identified 56 patients (51 men; median age 77 years, range 59–92), 28 with an endoleak and 28 without, who had digital CTA data available at baseline (first postoperative scan) and at 1 and 2 years after EVAR. Total aneurysm volume, transverse maximum diameter (TMD), and orthogonal maximum diameter (OMD; perpendicular to the aortic center lumen line) were compared for all patients and between those with and without endoleak. Differences of 5% for volume and 5 mm for diameters were considered a significant change. Kappa statistics were used to compare measurements. Results: Volumetry detected aneurysm growth in 32 (24%) of 131 scans, which was reflected by TMD in 12 (38%) and by OMD in 14 (44%). Eighteen scans with increasing aneurysm volume were measured in patients with endoleaks, which was documented by TMD in 6 (33%) and by OMD in 8 (44%). Fourteen volume increases were measured in patients without endoleak; both TMD and OMD documented only 43%. Volumetry detected aneurysm shrinkage in 71 (54%) of 131 scans [detected by TMD in 38 (54%) and by OMD in 37 (52%)]. Thirty-two volume decreases were measured in patients with an endoleak, noted by TMD in 18 (56%) and OMD in 14 (44%). Thirty-nine scans showed decreasing volumes in patients without endoleaks; the TMD corresponded in 20 (51%) and the OMD in 23 (59%). The kappa agreements for volume increase were 0.42 (TMD) and 0.35 (OMD) and for volume decrease 0.48 (TMD) and 0.47 (OMD); different thresholds of change produced similar moderate-range kappa values (0.3–0.6). Conclusion: Volumetry detects sac size changes that are not reflected in diameter measurements. Vice versa, diameters can increase without a total volume increase, which might indicate a variety of morphological aneurysm changes. The agreement between volume and diameter measurements using different cutoff values is equally moderate. Volume measurements should be performed in addition to diameter measurements.

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