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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.
, 1, 1
Affiliations- Department of Vascular Surgery and Angiology CMKP , Bielański Hospital, 80 Cegłowska Street, 01-809 Warsaw, Poland
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Abstract
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
NYHA Class III.
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).
Abstract
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
NYHA Class III.
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).
Keywords
abdominal aortic aneurysm AAA; EVAR management; measurement of EVAR device; kinking ( tortuosity ) of iliac arteries in AAA
About this articleTitle
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.
Journal
Issue
Article type
Research paper
Pages
39-43
Published online
2022-08-16
Page views
3587
Article views/downloads
238
DOI
Bibliographic record
Acta Angiologica 2022;28(2):39-43.
Keywords
abdominal aortic aneurysm AAA
EVAR management
measurement of EVAR device
kinking ( tortuosity ) of iliac arteries in AAA
Authors
Bartosz Pacewski
Piotr Słowiński
Grzegorz Madycki
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- 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.
- 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.
- Henretta JP, Karch LA, Hodgson KJ, et al. Special iliac artery considerations during aneurysm endografting. Am J Surg. 1999; 178(3): 212–218.
- 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.