Between July 2004 and December 2007, 301 patients underwent EVAR of an abdominal aortic aneurysm (AAA) with the ELPE at two institutions. Baseline sac size was measured by computed tomography (CT) scan at 1 month after repair. Follow-up beyond 1 year was either with a CT or ultrasound scan. Changes in sac size ≥5 mm from baseline were determined to be significant. Endoleak history was assessed with respect to sac behavior using χ2 and logistic regression analysis.
Two hundred sixteen patients (mean age 73.6 years and 76 % men) had at least 1-year follow-up imaging available for analysis. Mean follow-up was 2.6 years (range, 1-5 years). The average minor-axis diameter was 52 mm at baseline. The proportion of patients with sac regression was similar during the study period: 58 % , 66 % , 60 % , 59 % , and 63 % at 1 to 5 years, respectively. The proportion of patients with sac growth increased over time to 14.8 % at 4-year follow-up. The probability of freedom from sac growth at 4 years was 82.4 % . Eighty patients (37.7 % ) had an endoleak detected at some time during follow-up with 29.6 % (16 of 54) residual endoleak rate at 4 years; 13 of the residual 16 endoleaks were type II. All patients with sac growth had endoleaks at some time during the study compared with only 18 % of patients with sac regression (P < .0001).
A sustained sac regression after AAA exclusion with ELPE is noted up to 5-year follow-up. Sac enlargement was observed only in the setting of a current or previous endoleak, with no cases of suspected hygroma formation noted.