European Radiology

, Volume 29, Issue 12, pp 6591–6599 | Cite as

New predictors of aneurysm sac behavior after endovascular aortic aneurysm repair

  • Min-Jae Jeong
  • Hyunwook Kwon
  • Gi-Young Ko
  • Dong Il Gwon
  • Min-Ju Kim
  • Youngjin Han
  • Tae-Won Kwon
  • Yong-Pil ChoEmail author
Computed Tomography



This study aimed to identify new predictors of sac behavior after endovascular aortic aneurysm repair (EVAR) and to investigate whether sac behavior is associated with long-term clinical outcomes.


A total of 168 patients undergoing successful EVAR for abdominal aortic aneurysms with CTA follow-up of at least 1 year were included. Predictors of aneurysm sac behavior and its impact on long-term clinical outcomes were retrospectively analyzed.


According to sac behavior, eligible patients were stratified into the sac regression group (n = 79, 47.0%) and the sac non-regression group (n = 89, 53.0%). Patients in the regression group were younger (p = 0.036) and more likely to take sarpogrelate hydrochloride postoperatively (p = 0.011) than those in the non-regression group. The incidence of postimplantation syndrome (PIS) was significantly higher in the regression group (p = 0.005). On multivariate analysis, sac regression was more likely to occur in those with PIS (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.07–2.64; p = 0.023) and less likely to occur in those with transient type II endoleaks (HR, 0.43; 95% CI, 0.20–0.95; p = 0.037) and higher thrombus density within the sac on follow-up CTA (HR, 0.97; 95% CI, 0.95–0.99; p = 0.013). Non-regression of the sac was associated with significantly higher rates of re-intervention during the follow-up period (p = 0.001).


In addition to type II endoleaks, PIS and thrombus density are new predictors of aneurysm sac behavior, and sac regression is significantly associated with lower rates of re-intervention.

Key Points

After endovascular aortic aneurysm repair (EVAR), patients with sac regression were younger and more likely to take sarpogrelate hydrochloride postoperatively than those with sac non-regression.

The incidence of postimplantation syndrome (PIS) was significantly higher in patients with sac regression.

In our analysis, PIS and thrombus density within the sac were newly identified predictors of aneurysm sac behavior after EVAR.


Aortic aneurysm, abdominal Endovascular procedures Treatment outcomes 



Abdominal aortic aneurysm


Confidence interval


C-reactive protein


Duplex ultrasound


Endovascular aortic aneurysm repair


Hazard ratio


Hounsfield unit


Postimplantation syndrome


White blood cell



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this study is Yong-Pil Cho.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Min-Ju Kim) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (2018–0288).


• retrospective

• observational

• performed at one institution

Supplementary material

330_2019_6306_MOESM1_ESM.docx (3.8 mb)
ESM 1 (DOCX 3844 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Division of Vascular Surgery, Department of Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of Clinical Epidemiology and Biostatistics, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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