Endograft Limb Occlusion in EVAR: Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA
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Endograft Limb Occlusion in EVAR : Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA. / Taudorf, M; Jensen, L P; Vogt, K C; Grønvall, J; Schroeder, T V; Lönn, L.
In: European Journal of Vascular and Endovascular Surgery, Vol. 48, No. 5, 11.2014, p. 527-533.Research output: Contribution to journal › Journal article › Research › peer-review
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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
Y1 - 2014/11
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
VL - 48
SP - 527
EP - 533
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
SN - 1078-5884
IS - 5
ER -
ID: 138316005