Aneurysm sac regression following endovascular abdominal aortic aneurysm repair (EVAR) has been proposed as a marker of favorable remodeling and effective aneurysm exclusion. However, its true impact on long-term clinical outcomes had not been fully established. This meta-analysis evaluated the association between aneurysm sac regression and clinical events after EVAR.
A total of 27 observational studies involving 36,822 patients treated with EVAR were included. Of these, 19,023 patients (51.7%) experienced aneurysm sac regression during follow-up, defined in most studies as a reduction of ≥5 mm in the maximum sac diameter. Mean age ranged from 70.8 to 77.3 years, and 18.2% of patients were women. The primary endpoint was overall survival, while secondary endpoints included freedom from reintervention, occurrence of endoleak during follow-up, aneurysm rupture, and the need for additional reinterventions.
Sac regression was associated with a significant reduction in all-cause mortality (HR 0.70; 95% CI 0.61–0.80; p<0.00001) and improved freedom from reintervention (HR 0.37; 95% CI 0.27–0.53; p<0.00001). In addition, patients with sac regression had a lower incidence of endoleaks during follow-up (15.6% vs. 18.2%; p<0.0001), a lower rate of reinterventions (2.6% vs. 3.6%; p=0.002), and a reduced risk of aneurysm rupture (RR 0.31; 95% CI 0.15–0.61; p=0.001).
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In the subgroup of complex aneurysms treated with fenestrated or branched techniques (F/BEVAR), sac regression was also associated with a lower incidence of endoleaks (RR 0.50; 95% CI 0.27–0.93; p=0.03). However, differences in mortality, aneurysm rupture, and reintervention rates did not reach statistical significance.
Conclusión: Aneurysm Sac Regression Predicts Better Clinical Outcomes After EVAR
In conclusion, aneurysm sac regression following EVAR is consistently associated with improved survival and a lower incidence of aneurysm-related complications. These findings support the value of sac regression as a marker of favorable remodeling and as a potential risk stratification tool during the long-term follow-up of patients undergoing endovascular treatment.
Original Title: To regress or not to regress? Outcomes of aneurysm sac behavior after endovascular aortic aneurysm repair: A systematic review and meta-analysis.
