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Suitability of Ruptured AAA for Endovascular Repair

2004; SAGE Publishing; Volume: 11; Issue: 6 Linguagem: Inglês

10.1583/04-1275r.1

1545-1550

William R. Wilson, Guy Fishwick, Sir Peter Bell, Matthew M. Thompson,

Vascular Procedures and Complications

Purpose:To determine the anatomical suitability and the range of endografts required to undertake an endovascular repair (EVR) program for ruptured abdominal aortic aneurysms. Methods:The morphology of ruptured and nonruptured AAAs were compared by retrospective review of computed tomographic scans from 51 patients (47 men; mean age 76 years, range 55–90) with ruptured AAAs and 50 patients (37 men; mean age 74 years, range 57–75) with nonruptured AAAs. Three experienced clinicians reviewed the scans for EVR suitability based on a generic trimodular endograft with suprarenal fixation. Endograft oversizing was assumed to be 10% to 20%. Results:Interobserver agreement was high, with a mean kappa of 0.78 (range 0.75–0.83, p 0.001). Neck length and neck diameter were significantly correlated for ruptured AAAs (r=–0.34, p= 0.018). The main contraindication to EVR was hostile neck morphology. A range of endografts with aortic components from 24 to 32 mm and iliac components from 12 to 22 mm would be required to stent 41% of ruptured AAAs. Conclusions:Ruptured AAAs are less suitable for EVR due to differing neck morphology. An EVR program for ruptured AAA requires an inventory of endografts with appropriate aortic and iliac components.