Endograft Limb Occlusion in EVAR: Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA

TY - JOUR

T1 - Endograft Limb Occlusion in EVAR

T2 - Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA

AU - Taudorf, M

AU - Jensen, L P

AU - Vogt, K C

AU - Grønvall, J

AU - Schroeder, T V

AU - Lönn, L

N1 - Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - OBJECTIVE: To assess the incidence and outcome of graft limb occlusions after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) in a high volume single centre. To quantify iliac artery tortuosity in patients with AAA and correlate this with limb occlusion.DESIGN: Data were collected consecutively and prospectively, and analyzed retrospectively.MATERIALS: Patients treated with Zenith bifurcated stent grafts from January 2000 to December 2010 at a tertiary referral vascular unit were analyzed. Routine regular office follow-up with computed tomography angiography (CTA) and, subsequently, duplex ultrasound imaging was performed. Patients with limb occlusions were identified. For each index patient, two controls were obtained, one immediately preceding and one following the index patient in the consecutive cohort of EVAR patients.METHODS: Demographics and CTA data on limb graft occlusions were recorded and compared with a defined control group. Three different indices were used to describe the tortuosity of the iliac vessels based on preoperative CTA: pelvic artery index of tortuosity (PAI), common iliac artery index of tortuosity (CAI), and a visual description of vessel tortuosity - the double iliac sign (DIS). Demographic data and indices were correlated for later occurring limb occlusion.RESULTS: 504 patients underwent EVAR and 18 patients experienced graft limb occlusion during a median follow-up of 28 months (range 0-133). Primary graft patency was 97% at 1 year and 96% at 3 years. Logistic regression showed that iliac artery tortuosity (DIS) (p = .001) and body mass index (p = .007) had a significant impact on graft patency.CONCLUSION: A tortuous vessel on the preoperative CTA is associated with an increased risk of limb occlusion after EVAR. Adjunctive stenting of iliac segments deemed at risk is suggested, which is achieved without compromise of the aneurysm repair.

AB - OBJECTIVE: To assess the incidence and outcome of graft limb occlusions after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) in a high volume single centre. To quantify iliac artery tortuosity in patients with AAA and correlate this with limb occlusion.DESIGN: Data were collected consecutively and prospectively, and analyzed retrospectively.MATERIALS: Patients treated with Zenith bifurcated stent grafts from January 2000 to December 2010 at a tertiary referral vascular unit were analyzed. Routine regular office follow-up with computed tomography angiography (CTA) and, subsequently, duplex ultrasound imaging was performed. Patients with limb occlusions were identified. For each index patient, two controls were obtained, one immediately preceding and one following the index patient in the consecutive cohort of EVAR patients.METHODS: Demographics and CTA data on limb graft occlusions were recorded and compared with a defined control group. Three different indices were used to describe the tortuosity of the iliac vessels based on preoperative CTA: pelvic artery index of tortuosity (PAI), common iliac artery index of tortuosity (CAI), and a visual description of vessel tortuosity - the double iliac sign (DIS). Demographic data and indices were correlated for later occurring limb occlusion.RESULTS: 504 patients underwent EVAR and 18 patients experienced graft limb occlusion during a median follow-up of 28 months (range 0-133). Primary graft patency was 97% at 1 year and 96% at 3 years. Logistic regression showed that iliac artery tortuosity (DIS) (p = .001) and body mass index (p = .007) had a significant impact on graft patency.CONCLUSION: A tortuous vessel on the preoperative CTA is associated with an increased risk of limb occlusion after EVAR. Adjunctive stenting of iliac segments deemed at risk is suggested, which is achieved without compromise of the aneurysm repair.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Aneurysm, Abdominal

KW - Aortography

KW - Blood Vessel Prosthesis

KW - Female

KW - Graft Occlusion, Vascular

KW - Humans

KW - Iliac Artery

KW - Incidence

KW - Male

KW - Middle Aged

KW - Preoperative Period

KW - Retrospective Studies

KW - Risk Assessment

KW - Stents

KW - Treatment Outcome

KW - Vascular Surgical Procedures

U2 - 10.1016/j.ejvs.2014.04.018

DO - 10.1016/j.ejvs.2014.04.018

M3 - Journal article

C2 - 24878235

SN - 1078-5884

VL - 48

SP - 527

EP - 533

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

IS - 5

ER -