Changes in Aortoiliac Anatomy After Elective Treatment of Infrarenal Abdominal Aortic Aneurysms with a Sac Anchoring Endoprosthesis

Objective Endovascular aortic sealing (EVAS) with the Nellix endosystem (Endologix, Irvine, CA, USA) is a new concept to treat infrarenal abdominal aortic aneurysms (AAAs). By sealing the aneurysm, potential endoleaks may be avoided. Early results of EVAS are good, but no data have been published re...

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Published in:	European journal of vascular and endovascular surgery Vol. 51; no. 1; pp. 56 - 62
Main Authors:	Boersen, J.T, Schuurmann, R.C.L, Slump, C.H, van den Heuvel, D.A.F, Reijnen, M.M.P.J, ter Mors, T.G, Vahl, A.C, de Vries, J.P.P.M
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-01-2016
Subjects:	Aged Aorta, Abdominal - diagnostic imaging Aorta, Abdominal - surgery Aortic Aneurysm, Abdominal - diagnosis Aortic Aneurysm, Abdominal - surgery Aortography - methods Aortoiliac anatomy Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - instrumentation Elective Surgical Procedures Endovascular aneurysm sealing Endovascular Procedures - instrumentation Female Humans Iliac Artery - diagnostic imaging Iliac Artery - surgery Infrarenal abdominal aortic aneurysm Male Prosthesis Design Stents Surgery Time Factors Tomography, X-Ray Computed Treatment Outcome Aortoiliac anatomy Infrarenal abdominal aortic aneurysm Endovascular aneurysm sealing
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Summary:	Objective Endovascular aortic sealing (EVAS) with the Nellix endosystem (Endologix, Irvine, CA, USA) is a new concept to treat infrarenal abdominal aortic aneurysms (AAAs). By sealing the aneurysm, potential endoleaks may be avoided. Early results of EVAS are good, but no data have been published regarding peri-procedural changes in aortoiliac anatomy. In this study, 27 consecutive patients who underwent elective EVAS repair of an AAA were reviewed. Method Specific AAA (diameter, length from renal arteries to aortic bifurcation, supra- and infrarenal neck angulation, AAA volume, thrombus volume, and flow lumen volume), and iliac artery characteristics (length, angulation, location of most severe angulation with reference to the origin of the common iliac artery) were determined from pre- and post-procedural reconstructed computed tomography angiograms. Results No type I or II endoleaks were seen at 30 day follow up. Total AAA volume, suprarenal and infrarenal angulation, as well as aortic neck diameter did not change significantly post-EVAS. AAA flow lumen increased significantly (mean difference −4.4 mL, 95% CI 2.0 to −8.6 mL) and AAA thrombus volume decreased (mean difference 3.2 mL, 95% CI 2.0 to −1.1 mL). AAA length (125.7 mm vs. 123.1 mm), left common iliac artery length (57.6 mm vs. 55.3 mm), and right and left maximum iliac artery angulation (right 37.4° vs. 32.2°; left: 43.9° vs. 38.4°) were reduced significantly and the location of maximum angulation was further from the iliac artery origin post-EVAS, suggesting slight straightening of the aortoiliac anatomy. Conclusion Most aortoiliac anatomic characteristics remained unchanged post-EVAS. Filling of the endobags to a pressure of 180 mmHg may lead to lost thrombus volume in some patients, probably because liquid is squeezed into lumbar or the inferior mesenteric artery. The absolute differences in pre- and post-EVAS aortoiliac lengths were small, so pre-operative sizing is accurate for determining stent length.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1078-5884 1532-2165
DOI:	10.1016/j.ejvs.2015.08.019