Influence of type II endoleak volume on aneurysm wall pressure and distribution in an experimental model

Objective(s) We have previously shown that type II endoleak size is a predictor of aneurysm growth after aortic endografting. To better understand this observation, we investigated the influence of endoleak size on pressure transmitted to the aneurysm wall and its distribution within the aneurysm sac. Methods In an ex vivo model, an artificial aneurysm sac was incorporated within a mock circulation comprised of rubber tubing and a pulsatile pump. Three strain-gauge pressure transducers were placed in the aneurysm wall at different locations, including the site of maximum aneurysm diameter. The aneurysm was filled with either human aneurysm thrombus or dough that mimicked thrombus and simulated type II endoleaks of varying volumes (1 to 10 mL) were created. Aneurysm wall pressure (AWP) measurements were recorded at mean arterial pressures (MAPs) of 60, 80, and 100 mm Hg. Correlation coefficients ( r ) and analysis of variance were used to assess the relationship between endoleak volume and AWP. Results Increasing endoleak volume '3 cm 3 resulted in proportionally increased AWP at all levels of MAP and at all sites, with highest pressures recorded at the site of the maximum aneurysm diameter ( r = 0.83 when MAP=100 mm Hg; r = 0.85 when MAP=80 mm Hg; r = 0.88 when MAP=60 mm Hg; P 3 cm 3 . Pressure distribution within the sac was not uniform. Although the difference was within ±10%, statistically significant higher AWPs were observed at the site of maximum aneurysm diameter ( P Conclusions Increasing type II endoleak volume results in proportionally higher AWP, which is greatest at the site of maximum aneurysm diameter. This study confirms the clinical observation that type II endoleak volume and MAP may be important predictors of aneurysm expansion.