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An aggressive treatment policy is currently recommended for aneurysms without imaging-detected evidence of an endoleak that enlarge after EVAR.18?and?20 We analyzed the EUROSTAR database to investigate the risk of rupture in patients without detectable endoleaks on imaging studies. Aneurysm enlargement was defined as a diameter increase of >8 mm because of a presumably larger interobserver variability in the large number of institutions participating in the registry compared with a single-institution assessment.7, 24, 25?and?26 To our knowledge, this is the largest multicenter study to date evaluating the risk of rupture for this group. Our analysis demonstrated aneurysm enlargement without detectable endoleaks was an independent risk factor for AAA rupture after EVAR. Furthermore, a large preoperative AAA diameter, shorter infrarenal neck, and the Vanguard stent graft were independent risk factors Afatinib research buy for AAA rupture. However, group C had more patients with smaller preoperative diameters and shorter infrarenal necks. A reason for smaller AAAs in group C might be the 8 mm threshold. Shrinkage of >8 mm occurs predominantly in AAAs with large preoperative diameters. If a large preoperative AAA shrinks 15% in diameter, there is an increased chance of reaching the 8 mm threshold compared with a small preoperative AAA. Moreover, the multivariable analysis showed that preoperative AAA diameter and infrarenal neck length are buy CAL-101 not the only risk factors or the strongest risk factors; for example, Sitaxentan group C had an increased percentage of Vanguard stent grafts, which were strongly associated with rupture. The Excluder stent graft was more often used in group C. This is an important factor for AAA expansion, and thereby could possibly increase rupture risk in this group, regardless of the preoperative AAA diameter size. A large number of high-permeability Excluder stent grafts were implanted in group C, and 53 were not relined. The calculated mean annual rupture risk in group C over 7 years was 1.1%. This rupture risk is comparable with rupture rates in general after EVAR in other cohorts, as reported in literature.3, 9, 10, 11, 12, 13, 15?and?27 Furthermore, we observed an annual rate of rupture in group C of