The aim of the following review is to understand why this study was performed so that the Failure of the sac to regress at 12 months after endovascular aneurysm repair (EVAR) was reported to be associated with higher long-term mortality independent of reinterventions or endoleaks in a large Vascular Quality Initiative database. We reviewed our single-center closely monitored cohort of patients after elective EVAR to see whether sac behavior at 12 months affects survival, reintervention, and endoleak-free survival. All patients undergoing EVAR (15 fenestrated EVARs) between 2001 and 2018 with an imaging study at 1 year postoperatively (±6 months) were included. Those with sac diameter decrease ≥5 mm (group I, n = 238) were compared with those who remained stable (group II, n = 151) or increased (group III, n = 14). In closely monitored patients, failure of sac diameter decrease at 12 months is not associated with survival but is associated with new endoleaks and reinterventions. Patients with stable sacs should probably be more closely monitored as the endoleak and reintervention rate is significantly higher than for those with sac size decrease. During follow-up, 4.2% in group I had sac increase. In group II, 29.8% had sac size decrease, 58.3% remained stable, and 11.9% had sac size increase, half of which decreased again after reinterventions.

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