Endovascular repair of abdominal aortic aneurysm with the ancure endograft: CT follow-up of perigraft flow and aneurysm size at 6 months

PURPOSE: Perigraft flow-flow outside the graft lumen but contained within the abdominal aortic aneurysm (AAA)-is a potential complication after endovascular repair of AAA. Such flow may permit AAA growth and rupture. The purpose of this study is to evaluate with computed tomography (CT) the rate of spontaneous closure of perigraft flow and the effect of persistent flow on AAA diameter. MATERIALS AND METHODS: During a 30-month period, the authors evaluated all CT scans in 50 patients who underwent AAA repair using the Ancure endograft system CT was performed at discharge, 6, 12, and 24 months, and at 3 months if there was perigraft now at discharge. Scans were reviewed for the presence, size, and location of perigraft flow, and measurement of AAA diameter. Transcatheter embolization was performed on those patients with persistent leak at 6 months. RESULTS: Sixteen (32%) of 50 patients demonstrated perigraft flow on CT performed within 72 hours of placement. Resolution of perigraft flow by 6 months was found in nine (56%) of the 16 patients, in whom AAA size had decreased in five, had increased in none, and was unchanged in four. Seven patients had persistent leaks at g-month CT; AAA size had decreased in one, had increased in one, and was unchanged in five. In 34 patients without leaks, AAA size had decreased in nine, had increased in one, and was unchanged on 24. There was no statistically significant difference for the relationship between resolution or persistence of perigraft flow and subsequent course of AAA diameter (P = .16). CONCLUSIONS: Although perigraft flow is frequently seen (32%) early after repair of AAA with the Ancure system, spontaneous resolution by 6 months occurs in 56% of cases. AAA size decreased in a larger percentage of patients in whom perigraft leak was absent or resolved by 6 months compared with those in whom perigraft leak persisted at 6 months.