Abstract
The purpose of this study was to evaluate the accuracy of centerline of flow (CLF) measurement for precise sizing of the Zenith AAA endovascular graft (Zenith) and to identify predictive factors of risk of inadequate endograft sizing. We analyzed 42 consecutive patients treated using the Zenith with pre- and postoperative multidetector CT between 2001 and 2007. Endograft sizing was retrospectively performed using CLF on a three-dimensional workstation. The following parameters were investigated: (a) change in distance from lowest renal artery to hypogastric artery between CLF on preoperative CT (CLFp) and CLF of graft path on postoperative CT (CLFg); (b) supposed success rate of adequate endograft length selection; and (c) predictive factors for significant alteration (>10 mm) between CLFp and CLFg. Median change in distance from lowest renal artery to hypogastric artery was 4 mm. CLFg was >10 mm shorter than CLFp in 10 of 84 limbs (12%). Multivariate analysis demonstrated tortuosity index (TI) of infrarenal abdominal aorta (p = 0.019), aneurysm diameter (p = 0.035), and ipsilateral side of the main body insertion (p = 0.042) as predictive factors of significant alteration between CLFp and CLFg. Adequate endograft length selection was achieved in 39 of 42 cases (93%). All three inadequate endograft length selections were associated with tortuous aorta (TI > 20 mm). In conclusion, distance calculations based on CLF measurement provided accurate length selection of the Zenith in the majority of cases. TI, aneurysm diameter, and ipsilateral side were predictive factors for significant alteration. The CLF and aortic measurements including the TI may allow for improved sizing for Zenith placements.
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References
EVAR Trial Participants (2005) Endovascular aneurysm repair versus open in patients with abdominal aortic aneurysm (EVAR trial 1): randomized controlled trial. Lancet 365:2176–2186
Schermerhorn ML, O’Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the medicare population. N Engl J Med 358:464–474
Parker MV, O’Donnel SD, Chang AS et al (2005) What imaging studies are necessary for abdominal aortic endograft sizing? A prospective blinded study using conventional computed tomography, aortography, and three-dimensional computed tomography. J Vasc Surg 41:199–205
Velazquez OC, Woo EY, Carpenter JP et al (2004) Decreased use of iliac extensions and reduced graft junctions with software-assisted centerline measurements in selection of endograft components for endovascular aneurysm repair. J Vasc Surg 40:222–227
Whittaker DR, Dwyer J, Fillinger MF (2005) Prediction of altered endograft path during endovascular abdominal aortic aneurysm repair with the Gore excluder. J Vasc Surg 41:575–583
Tiilich M, Hill BB, Paik DS et al (2001) Prediction of aortoiliac stent-graft length: comparison of measurement methods. Radiology 220:475–483
Coenegrachts K, Rigauts H, De Letter J (2003) Prediction of aortoiliac stent graft length: comparison of a semiautomated computed tomography angiography method and calibrated aortography. J Comput Assist Tomogr 27:284–288
Wyers MC, Fillinger MF, Schermerhorn ML et al (2003) Endovascular repair of abdominal aortic aneurysm without preoperative arteriography. J Vasc Surg 38:730–738
Diehm N, Herrmann P, Dinkel HP (2004) Multidetector CT angiography versus digital subtraction angiography for aortoiliac length measurements prior to endovascular AAA repair. J Endovasc Ther 11:527–534
O’Neill S, Greenberg RK, Haddad F et al (2006) A prospective analysis of fenestrated endovascular grafting: intermediate-term outcomes. Eur J Vasc Endovasc Surg 32:115–123
Greenberg RK, West K, Pfaff K et al (2006) Beyond the aortic bifurcation: branched endovascular grafts for thoracoabdominal and aortoiliac aneurysms. J Vasc Surg 43:879–886
O’Neill S, Greenberg RK, Resch T et al (2006) An evaluation of centerline of flow measurement techniques to assess migration after thoracic endovascular aneurysm repair. J Vasc Surg 43:1103–1110
Higashiura W, Sakaguchi S, Kichikawa K et al (2008) Mid-term outcomes of endovascular repair using Zenith AAA endovascular graft: does ipsilateral limb level of main body affect outcome? J Vasc Interv Radiol 19:848–854
Greenberg RK, on behalf of the Zenith Investigators (2003) The Zenith AAA endovascular graft for abdominal aortic aneurysms: clinical update. Semin Vasc Surg 16:151–157
Hobo R, Laheij RJF, Buth J et al (2007) The influence of aortic cuffs and iliac limb extensions on the outcome of endovascular abdominal aortic aneurysm repair. J Vasc Surg 45:79–85
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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 32, 441–448 (2009). https://doi.org/10.1007/s00270-009-9531-9
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DOI: https://doi.org/10.1007/s00270-009-9531-9