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Vol 28, No 2 (2022)
Research paper
Published online: 2022-08-16

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The phenomenon of stentgraft “shortening” during endovascular stentgraft implantation into an abdominal aortic aneurysm in cases involving significant tortuosity of the aorta and iliac arteries.

Bartosz Pacewski1, Piotr Słowiński1, Grzegorz Madycki1
Acta Angiologica 2022;28(2):39-43.


Introduction: One of the main problems with the implantation of stent-graft (STG) in the abdominal aortic

aneurysm (AAA) remains its proper fit. Minor differences in distances from the relevant structures can result

in life-threatening complications. This article aims to show the problem of aortic stent-graft shortening during

implantation. This occurs in the case of significant tortuosity of the abdominal aorta vessels and iliac arteries.

Our study has found a significant correlation between vessel tortuosity and erroneous results of preoperative

sizing (using the centerline). The new measurement system developed (along long curves) seems to correlate

better with intraoperative images.

Material and methods: The study involved the evaluation of 70 patients sized classically and with the use

of the described technique, and then operated on with the EVAR technique. In all patients, stent-grafts were

sized classically (using the central lumen line) and along the curvature line of the sized vessels. The dimensions

of the stent-graft were selected according to the standard method (classical sizing), and the fit of the STG in

relation to the calibrated catheter (“pigtail”), and the final postoperative result was considered to be the final

result. There were 44 men (62,8%) and 26 women (37,2 %) in the study group. The mean age of patients

was 74 years. Eighty-nine percent of patients were classified as NYHA (Class I-II) and 11 % of patients as


Results: Average measurement of the aorta and iliac arteries using the centerline was 201.8 mm, and

average measurement based on the curvature of vessels was 222.2 mm. Average measurement using

calibrated catheter was 218.1 mm. The results of the analysis showed significant differences between the

measurements (centerline and long curvature of vessel): Z = 7.17; p < 0.001; r = 0.87.

Conclusions: The measurement made along the long curves is more accurate than the measurement

made with the centerline. The measurement made with the centerline is underestimated (it indicates

a smaller value than the actual measurement).

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  1. Lee K, Hossain S, Sabalbal M, et al. Explaining endograft shortening during endovascular repair of abdominal aortic aneurysms in severe aortoiliac tortuosity. J Vasc Surg. 2017; 65(5): 1297–1304.
  2. Higashiura W, Kichikawa K, Sakaguchi S, et al. Accuracy of centerline of flow measurement for sizing of the Zenith AAA endovascular graft and predictive factor for risk of inadequate sizing. Cardiovasc Intervent Radiol. 2009; 32(3): 441–448.
  3. Lee K, Hossain S, Sabalbal M, et al. Endograft conformability and aortoiliac tortuosity in endovascular abdominal aortic aneurysm repair. J Endovasc Ther. 2014; 21(5): 728–734.
  4. Wyss TR, Dick F, Brown LC, et al. The influence of thrombus, calcification, angulation, and tortuosity of attachment sites on the time to the first graft-related complication after endovascular aneurysm repair. J Vasc Surg. 2011; 54(4): 965–971.
  5. Henretta JP, Karch LA, Hodgson KJ, et al. Special iliac artery considerations during aneurysm endografting. Am J Surg. 1999; 178(3): 212–218.
  6. Coulston J, Baigent A, Selvachandran H, et al. The impact of endovascular aneurysm repair on aortoiliac tortuosity and its use as a predictor of iliac limb complications. J Vasc Surg. 2014; 60(3): 585–589.