ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1684466
This article is part of the Research TopicRevolutionizing Aortic Repair: Advanced Surgical and Endovascular Techniques for Comprehensive Aortic Management from the Aortic Valve to the Abdominal AortaView all 5 articles
Morphovolumetric Analysis of Aneurysm Sac and Correlation with Maximum Diameter for Post-EVAR Surveillance
Provisionally accepted
- 1TC Saglik Bakanligi Iskenderun Devlet Hastanesi, Iskenderun, Türkiye
- 2Cardiovascular Surgery, TC Saglik Bakanligi Kilis Prof Dr Alaeddin Yavasca Devlet Hastanesi, Kilis, Türkiye
- 3Cardiovascular Surgery, TC Saglik Bakanligi Agri Egitim ve Arastirma Hastanesi, Ağrı, Türkiye
- 4Department of Radiology, TC Saglik Bakanligi Ankara Sehir Hastanesi, Çankaya, Türkiye
- 5Cardiovascular Surgery, TC Saglik Bakanligi Ankara Sehir Hastanesi, Çankaya, Türkiye
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Introduction: Endovascular Aortic Repair (EVAR) is the current treatment of choice for suitable patients undergoing abdominal aortic aneurysm surgery, and post-EVAR follow-up has become an increasingly important topic. This study aims to identify factors influencing the remodeling of aneurysms post-EVAR and assess a more effective follow-up protocol using post-EVAR morphovolumetric analysis. Method: Between 2019 and 2023, 131 patients who underwent elective Endovascular Aortic Repair (EVAR) at our hospital and patients who had preoperative Computed Tomographic Angiography (CTA) were included in the study. Maximum aneurysm sac diameter, volume, thrombus volume, and infrarenal aortic neck angulation were measured. A post-EVAR volume reduction of 10% or more in the aneurysmal sac was considered a “positive remodeling" based on volumetric analysis. The reliability of post-EVAR surveillance and its correlation with the maximum diameter (Dmax) was evaluated. Results: Preoperative aneurysm volume larger than 233.5 cm3 (p=0.001) and thrombus volume greater than 204 cm3 (p=0.002) were associated with secondary interventions. Morphological changes after EVAR included neck dilatation (p<0.001) and decreased neck angulation (p<0.001). An alpha angle >47.5 degrees was associated with Type 1a endoleak (p=0.046). In the follow-up, positive remodeling was observed in 44 out of 131 patients (33.6%). The identification of more than four lumbar arteries preoperatively (p=0.003), the use of Double Antiplatelet Therapy (DAPT) postoperatively (p=0.017), and the presence of any type of endoleak were factors associated with negative remodeling. Conclusion: Post-EVAR morphological changes include reduced infrarenal aortic lengthening and neck dilatation. Lifelong surveillance is imperative after EVAR. The most effective method of organizing these surveillance protocols may involve a combination of Dmax and volume analysis, allowing for the most economical and reliable monitoring. Dmax is currently the fastest and most reliable data in post-EVAR surveillance. However, following our current study, we observed that relying solely on Dmax can be deceptive and should be correlated with volume analysis data.
Keywords: EVAR, Volumetric analysis, abdominal aort aneurysm, graft, Endovascular
Received: 12 Aug 2025; Accepted: 17 Oct 2025.
Copyright: © 2025 Türkcü, Külahcıoğlu, Cetinkaya, Dağlı and İşcan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mehmet Ali Türkcü, mehmetaliturkcu@gmail.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.