Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts

Stephane Elkouri, Eugenio Martelli, Peter Gloviczki, Michael A. McKusick, Jean M. Panneton, James C. Andrews, Audra A. Noel, Thomas C. Bower, Timothy M. Sullivan, Charles Rowland, Tanya L. Hoskin, Kenneth J. Cherry

Research output: Contribution to journalReview article

68 Citations (Scopus)

Abstract

Strict morphologic criteria must be used for patient selection to achieve durable success with endovascular aortic aneurysm repair (EVAR). The goal of this study was to assess morphologic suitability (MS) of abdominal aortic aneurysms (AAAs) for 2 currently approved bifurcated stent grafts and identify reasons for exclusion from EVAR. The authors reviewed the electronic charts of 1,795 consecutive patients who were diagnosed as having AAA between January 1999 and July 2001 at their institution. Three hundred and twenty patients had an AAA with a diameter of ≥ 5.0 cm, measured on computed tomography (CT). The records of 301 patients, 254 men, 47 women, with a mean age of 74 years were available for review, and these patients constituted the study cohort. Criteria used for MS included a proximal neck length ≥ 15 mm; neck diameter between 18 and 26 mm; neck angulation ≤ 60°; common or external iliac artery (CIA or EIA) diameters of 7-16 mm and 8-13 mm, respectively, for AneuRx (Medtronic Ave, Santa Rosa, CA) and Ancure (Guidant Cardiac and Vascular Division, Menlo Park, CA) bifurcated grafts. AAAs were suitable for AneuRx device in 14% of patients (43 of 301; 95% CI = 11-19%) and for Ancure in 5% (16 of 301; 95% CI = 3.1-9%). The main reason for exclusion was an inadequate proximal aortic neck (73%). The neck was too short in 49.5%, too wide in 64% and badly angulated in 12% of the patients. Iliac artery morphology precluded EVAR with AneuRx and Ancure devices in 52% and 80%. Both CIAs were too wide for EVAR in 43% and 77%, respectively. When iliac artery diameter ≤ 20 mm was accepted, iliac suitability for AneuRx increased from 49% to 70% and overall suitability increased from 14% to 20%. When more permissive criteria were used for MS (neck length ≥ 10 mm, neck diameter ≤ 30 mm, CIA ≤ 20), 39% of patients became candidates for EVAR. More than three fourths of the patients with an AAA ≥ 5.0 cm in size, seen in a tertiary referral center, are morphologically not suitable for EVAR using 2 currently approved bifurcated endografts. The main reasons for exclusion are a short or wide proximal aortic neck. Considerable changes in size of the devices and in proximal attachment techniques have to occur before most AAAs will be suitable for EVAR.

Original languageEnglish (US)
Pages (from-to)401-412
Number of pages12
JournalVascular and Endovascular Surgery
Volume38
Issue number5
DOIs
StatePublished - Sep 2004

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Abdominal Aortic Aneurysm
Aortic Aneurysm
Stents
Transplants
Neck
Iliac Artery
Equipment and Supplies
Tertiary Care Centers
Patient Selection
Birds
Blood Vessels
Cohort Studies
Tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts. / Elkouri, Stephane; Martelli, Eugenio; Gloviczki, Peter; McKusick, Michael A.; Panneton, Jean M.; Andrews, James C.; Noel, Audra A.; Bower, Thomas C.; Sullivan, Timothy M.; Rowland, Charles; Hoskin, Tanya L.; Cherry, Kenneth J.

In: Vascular and Endovascular Surgery, Vol. 38, No. 5, 09.2004, p. 401-412.

Research output: Contribution to journalReview article

Elkouri, S, Martelli, E, Gloviczki, P, McKusick, MA, Panneton, JM, Andrews, JC, Noel, AA, Bower, TC, Sullivan, TM, Rowland, C, Hoskin, TL & Cherry, KJ 2004, 'Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts', Vascular and Endovascular Surgery, vol. 38, no. 5, pp. 401-412. https://doi.org/10.1177/153857440403800502
Elkouri, Stephane ; Martelli, Eugenio ; Gloviczki, Peter ; McKusick, Michael A. ; Panneton, Jean M. ; Andrews, James C. ; Noel, Audra A. ; Bower, Thomas C. ; Sullivan, Timothy M. ; Rowland, Charles ; Hoskin, Tanya L. ; Cherry, Kenneth J. / Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts. In: Vascular and Endovascular Surgery. 2004 ; Vol. 38, No. 5. pp. 401-412.
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abstract = "Strict morphologic criteria must be used for patient selection to achieve durable success with endovascular aortic aneurysm repair (EVAR). The goal of this study was to assess morphologic suitability (MS) of abdominal aortic aneurysms (AAAs) for 2 currently approved bifurcated stent grafts and identify reasons for exclusion from EVAR. The authors reviewed the electronic charts of 1,795 consecutive patients who were diagnosed as having AAA between January 1999 and July 2001 at their institution. Three hundred and twenty patients had an AAA with a diameter of ≥ 5.0 cm, measured on computed tomography (CT). The records of 301 patients, 254 men, 47 women, with a mean age of 74 years were available for review, and these patients constituted the study cohort. Criteria used for MS included a proximal neck length ≥ 15 mm; neck diameter between 18 and 26 mm; neck angulation ≤ 60°; common or external iliac artery (CIA or EIA) diameters of 7-16 mm and 8-13 mm, respectively, for AneuRx (Medtronic Ave, Santa Rosa, CA) and Ancure (Guidant Cardiac and Vascular Division, Menlo Park, CA) bifurcated grafts. AAAs were suitable for AneuRx device in 14{\%} of patients (43 of 301; 95{\%} CI = 11-19{\%}) and for Ancure in 5{\%} (16 of 301; 95{\%} CI = 3.1-9{\%}). The main reason for exclusion was an inadequate proximal aortic neck (73{\%}). The neck was too short in 49.5{\%}, too wide in 64{\%} and badly angulated in 12{\%} of the patients. Iliac artery morphology precluded EVAR with AneuRx and Ancure devices in 52{\%} and 80{\%}. Both CIAs were too wide for EVAR in 43{\%} and 77{\%}, respectively. When iliac artery diameter ≤ 20 mm was accepted, iliac suitability for AneuRx increased from 49{\%} to 70{\%} and overall suitability increased from 14{\%} to 20{\%}. When more permissive criteria were used for MS (neck length ≥ 10 mm, neck diameter ≤ 30 mm, CIA ≤ 20), 39{\%} of patients became candidates for EVAR. More than three fourths of the patients with an AAA ≥ 5.0 cm in size, seen in a tertiary referral center, are morphologically not suitable for EVAR using 2 currently approved bifurcated endografts. The main reasons for exclusion are a short or wide proximal aortic neck. Considerable changes in size of the devices and in proximal attachment techniques have to occur before most AAAs will be suitable for EVAR.",
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T1 - Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts

AU - Elkouri, Stephane

AU - Martelli, Eugenio

AU - Gloviczki, Peter

AU - McKusick, Michael A.

AU - Panneton, Jean M.

AU - Andrews, James C.

AU - Noel, Audra A.

AU - Bower, Thomas C.

AU - Sullivan, Timothy M.

AU - Rowland, Charles

AU - Hoskin, Tanya L.

AU - Cherry, Kenneth J.

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N2 - Strict morphologic criteria must be used for patient selection to achieve durable success with endovascular aortic aneurysm repair (EVAR). The goal of this study was to assess morphologic suitability (MS) of abdominal aortic aneurysms (AAAs) for 2 currently approved bifurcated stent grafts and identify reasons for exclusion from EVAR. The authors reviewed the electronic charts of 1,795 consecutive patients who were diagnosed as having AAA between January 1999 and July 2001 at their institution. Three hundred and twenty patients had an AAA with a diameter of ≥ 5.0 cm, measured on computed tomography (CT). The records of 301 patients, 254 men, 47 women, with a mean age of 74 years were available for review, and these patients constituted the study cohort. Criteria used for MS included a proximal neck length ≥ 15 mm; neck diameter between 18 and 26 mm; neck angulation ≤ 60°; common or external iliac artery (CIA or EIA) diameters of 7-16 mm and 8-13 mm, respectively, for AneuRx (Medtronic Ave, Santa Rosa, CA) and Ancure (Guidant Cardiac and Vascular Division, Menlo Park, CA) bifurcated grafts. AAAs were suitable for AneuRx device in 14% of patients (43 of 301; 95% CI = 11-19%) and for Ancure in 5% (16 of 301; 95% CI = 3.1-9%). The main reason for exclusion was an inadequate proximal aortic neck (73%). The neck was too short in 49.5%, too wide in 64% and badly angulated in 12% of the patients. Iliac artery morphology precluded EVAR with AneuRx and Ancure devices in 52% and 80%. Both CIAs were too wide for EVAR in 43% and 77%, respectively. When iliac artery diameter ≤ 20 mm was accepted, iliac suitability for AneuRx increased from 49% to 70% and overall suitability increased from 14% to 20%. When more permissive criteria were used for MS (neck length ≥ 10 mm, neck diameter ≤ 30 mm, CIA ≤ 20), 39% of patients became candidates for EVAR. More than three fourths of the patients with an AAA ≥ 5.0 cm in size, seen in a tertiary referral center, are morphologically not suitable for EVAR using 2 currently approved bifurcated endografts. The main reasons for exclusion are a short or wide proximal aortic neck. Considerable changes in size of the devices and in proximal attachment techniques have to occur before most AAAs will be suitable for EVAR.

AB - Strict morphologic criteria must be used for patient selection to achieve durable success with endovascular aortic aneurysm repair (EVAR). The goal of this study was to assess morphologic suitability (MS) of abdominal aortic aneurysms (AAAs) for 2 currently approved bifurcated stent grafts and identify reasons for exclusion from EVAR. The authors reviewed the electronic charts of 1,795 consecutive patients who were diagnosed as having AAA between January 1999 and July 2001 at their institution. Three hundred and twenty patients had an AAA with a diameter of ≥ 5.0 cm, measured on computed tomography (CT). The records of 301 patients, 254 men, 47 women, with a mean age of 74 years were available for review, and these patients constituted the study cohort. Criteria used for MS included a proximal neck length ≥ 15 mm; neck diameter between 18 and 26 mm; neck angulation ≤ 60°; common or external iliac artery (CIA or EIA) diameters of 7-16 mm and 8-13 mm, respectively, for AneuRx (Medtronic Ave, Santa Rosa, CA) and Ancure (Guidant Cardiac and Vascular Division, Menlo Park, CA) bifurcated grafts. AAAs were suitable for AneuRx device in 14% of patients (43 of 301; 95% CI = 11-19%) and for Ancure in 5% (16 of 301; 95% CI = 3.1-9%). The main reason for exclusion was an inadequate proximal aortic neck (73%). The neck was too short in 49.5%, too wide in 64% and badly angulated in 12% of the patients. Iliac artery morphology precluded EVAR with AneuRx and Ancure devices in 52% and 80%. Both CIAs were too wide for EVAR in 43% and 77%, respectively. When iliac artery diameter ≤ 20 mm was accepted, iliac suitability for AneuRx increased from 49% to 70% and overall suitability increased from 14% to 20%. When more permissive criteria were used for MS (neck length ≥ 10 mm, neck diameter ≤ 30 mm, CIA ≤ 20), 39% of patients became candidates for EVAR. More than three fourths of the patients with an AAA ≥ 5.0 cm in size, seen in a tertiary referral center, are morphologically not suitable for EVAR using 2 currently approved bifurcated endografts. The main reasons for exclusion are a short or wide proximal aortic neck. Considerable changes in size of the devices and in proximal attachment techniques have to occur before most AAAs will be suitable for EVAR.

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