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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Aneurysm Sac Expansion After EVAR: Associated Factors, Prognostic Impact, and Preventive Strategies—A Systematic Review and Meta-Analysis

  • María Lourdes del Río-Solá1,2,3
  • Sergio Asensio-Rodríguez2
  • Sandra Pérez-Fernández2
  • Marina Jiménez-Caja2
  • Clara de la Torre Casaseca2
  1. 1Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 47005 Valladolid, Spain
  2. 2Department of Vascular Surgery, University Clinical Hospital of Valladolid, 47003 Valladolid, Spain
  3. 3Department of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain
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Abstract

Background/Objectives: Aneurysm sac expansion is an adverse marker of durability after endovascular aneurysm repair (EVAR). We assessed factors associated with expansion, its prognostic significance, and the effect of preventive embolisation. Methods: PubMed/MEDLINE, Web of Science, and Scopus were searched through 23 August 2026 (PROSPERO CRD420261386132). Random-effects meta-analyses analysed odds ratios (ORs), hazard ratios (HRs), and risk ratios (RRs) separately; risk of bias and certainty were assessed with RoB 2, ROBINS-I, QUIPS, and GRADE. Results: Thirty-three reports (20 independent quantitative studies) were included. Type II endoleak (OR 5.16, 95% confidence interval [CI] 2.53–10.50; HR 3.08, 95% CI 2.11–4.49) and type I endoleak (OR 11.94, 95% CI 5.30–26.90) were associated with expansion (low certainty). Expansion was associated with higher late mortality in a single independent adjusted cohort (HR 1.31, 95% CI 1.14–1.51; very low certainty). Preventive embolisation was associated with lower risks of persistent type II endoleak (RR 0.58, 95% CI 0.34–0.97; low certainty) and reintervention (RR 0.44, 95% CI 0.24–0.82; very low certainty), but neither association remained statistically conclusive in sensitivity analyses. Conclusions: Endoleaks are consistently associated with sac expansion, which appears to identify patients at increased late risk. Effects of preventive embolisation on surrogate outcomes are not robust; prevention of sac expansion and clinical events is unproven.

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Cite

BibTeXRIS
BibTeX
@article{riosola2026aneurysm,
  title = {{Aneurysm Sac Expansion After EVAR: Associated Factors, Prognostic Impact, and Preventive Strategies—A Systematic Review and Meta-Analysis}},
  author = {María Lourdes del Río-Solá and Sergio Asensio-Rodríguez and Sandra Pérez-Fernández and Marina Jiménez-Caja and Clara de la Torre Casaseca},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15208009},
  url = {https://www.mdpi.com/2077-0383/15/20/8009},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Aneurysm Sac Expansion After EVAR: Associated Factors, Prognostic Impact, and Preventive Strategies—A Systematic Review and Meta-Analysis
AU  - María Lourdes del Río-Solá
AU  - Sergio Asensio-Rodríguez
AU  - Sandra Pérez-Fernández
AU  - Marina Jiménez-Caja
AU  - Clara de la Torre Casaseca
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15208009
UR  - https://www.mdpi.com/2077-0383/15/20/8009
AB  - Background/Objectives: Aneurysm sac expansion is an adverse marker of durability after endovascular aneurysm repair (EVAR). We assessed factors associated with expansion, its prognostic significance, and the effect of preventive embolisation. Methods: PubMed/MEDLINE, Web of Science, and Scopus were searched through 23 August 2026 (PROSPERO CRD420261386132). Random-effects meta-analyses analysed odds ratios (ORs), hazard ratios (HRs), and risk ratios (RRs) separately; risk of bias and certainty were assessed with RoB 2, ROBINS-I, QUIPS, and GRADE. Results: Thirty-three reports (20 independent quantitative studies) were included. Type II endoleak (OR 5.16, 95% confidence interval [CI] 2.53–10.50; HR 3.08, 95% CI 2.11–4.49) and type I endoleak (OR 11.94, 95% CI 5.30–26.90) were associated with expansion (low certainty). Expansion was associated with higher late mortality in a single independent adjusted cohort (HR 1.31, 95% CI 1.14–1.51; very low certainty). Preventive embolisation was associated with lower risks of persistent type II endoleak (RR 0.58, 95% CI 0.34–0.97; low certainty) and reintervention (RR 0.44, 95% CI 0.24–0.82; very low certainty), but neither association remained statistically conclusive in sensitivity analyses. Conclusions: Endoleaks are consistently associated with sac expansion, which appears to identify patients at increased late risk. Effects of preventive embolisation on surrogate outcomes are not robust; prevention of sac expansion and clinical events is unproven.
SN  - 2077-0383
ER  -