Endovascular vs Open AAA Repair: Does Size Matter?

Since the natural tendency of the aorta is to increase in diameter and tortuosity with age and since abdominal aortic aneurysms (AAAs) increase in diameter and length over time, encroaching on the renal and hypogastric orifices, early repair of AAAs (when =4.0 cm) may allow greater applicability of...

Full description

Saved in:
Bibliographic Details
Published in:Vascular and endovascular surgery 2005-07, Vol.39 (4), p.307-315
Main Authors: Lalka, Stephen G., Dalsing, Michael C., Sawchuk, Alan P., Cikrit, Dolores F., Shafique, Shoaib
Format: Article
Language:English
Subjects:
Abdomen
Aged
Aged, 80 and over
Aorta, Abdominal - diagnostic imaging
Aorta, Abdominal - pathology
Aorta, Abdominal - surgery
Aortic Aneurysm, Abdominal - diagnostic imaging
Aortic Aneurysm, Abdominal - pathology
Aortic Aneurysm, Abdominal - surgery
Aortic Aneurysm, Abdominal - therapy
Biological and medical sciences
Blood and lymphatic vessels
Blood Vessel Prosthesis
Cardiology. Vascular system
Catheterization - instrumentation
Catheterization - methods
Diseases of the aorta
Humans
Iliac Artery - diagnostic imaging
Iliac Artery - pathology
Iliac Artery - surgery
Medical sciences
Middle Aged
Patient Selection
Prospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Tomography, X-Ray Computed
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
Vascular Surgical Procedures - instrumentation
Vascular Surgical Procedures - methods
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Since the natural tendency of the aorta is to increase in diameter and tortuosity with age and since abdominal aortic aneurysms (AAAs) increase in diameter and length over time, encroaching on the renal and hypogastric orifices, early repair of AAAs (when =4.0 cm) may allow greater applicability of the endovascular option because of more favorable aortoiliac morphology. Patients who present at an older age with larger AAAs should be more likely to be anatomically excluded from endovascular AAA repair. Over a 42-month period, 317 consecutive patients referred with aortoiliac aneurysms (infrarenal AAA =4.0 cm) were evaluated by one of the authors (SGL) for endovascular vs open repair based on computed tomography (CT) and angiographic imaging. The 10 anatomic exclusion criteria were those applicable to the Zenith ® endograft (Cook, Inc), which currently is the most anatomically inclusive of the aortic endografts in commercial use in the United States. Based on their aortoiliac morphology, 212 patients were excluded from endovascular repair and 105 were included as acceptable anatomic candidates. Age, AAA size, and the reason(s) for exclusion were recorded for each patient. By use of Student's t test and logistic and linear regression analyses, the groups were compared by age, AAA size, and age + size. There was no significant difference in patient age or AAA size distribution between the group of patients excluded from endovascular repair based on aortoiliac morphology compared to those who met the inclusion criteria. Patients with small AAAs (4.0–5.4 cm) had similar age distribution as those with large (=5.5 cm) AAAs. The majority of patients (87%) were excluded based on proximal aortic neck morphology. The presence of aortoiliac morphology that precludes endovascular repair is independent of patient age or AAA size at presentation. A patient presenting with a small (4.0–5.4 cm) AAA is not more likely to be a candidate for endovascular repair than a patient with a large AAA.
ISSN:1538-5744
1938-9116
DOI:10.1177/153857440503900402