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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2016 Sep 16

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Iliac and femoro-popliteal arteries morphological CTA features as determinants of outcome after standard EVAR procedures

Pasqualino SIRIGNANO 1, Francesco SPEZIALE 1, Laura CAPOCCIA 1, Danilo MENNA 1, Wassim MANSOUR 1, Nunzio MONTELIONE 1, Francesco SETACCI 2, Giuseppe GALZERANO 2, Carlo SETACCI 2

1 Vascular and Endovascular Surgery Unit, “Sapienza” University of Rome, Rome, Italy; 2 Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy


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BACKGROUND: To evaluate the impact of iliac artery’s diameters, tortuosity, and peripheral vascular patency on outcome of elective endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) in 2 high volume vascular centers’ experience.
METHODS: A retrospective study was conducted on a prospectively collected database between 2010 and 2012. Anatomical features at pre-operative computed tomography (CTA) considered as potentially influencing outcomes were: iliac diameters, tortuosity (expressed as a ratio), and calcifications, bilateral internal iliac artery (IIA) patency, and presence of Trans-Atlantic Inter-Societies Consensus (TASC) II C/D femoro-popliteal occlusive disease (PAD). Outcome measures were reintervention and mortality rates at follow-up.
RESULTS: Two-hundred-eighty-nine patients’ CTA preoperative images were reviewed with a mean of 1148±328 images per patient analysed. Mean common iliac artery (CIA) diameters calculated in the narrowest point were 12.8±4 mm and 12.9±3.9mm, and mean external iliac artery (EIA) diameters were 7.7±1.6mm 7.8±1.7mm, respectively on right and left side. Mean tortuosity ratios were 0.8±0.1 (0.40-0.91) and 0.8±0.1 (0.49-0.99), respectively on right and left side. PAD was present in 31 patients (10.7%). Technical success was achieved in all case, and bilateral IIA patency was preserved in 229 (79.2%) patients. No in hospital and 30-day mortality and complications were recorded. At a mean follow-up of 26 months, 30 reinterventions were required in 26 patients (8.9%), and 22 (7.6%) non AAA-related deaths were noted. Right EIA diameter ≤5mm(P=.0012, OR 5.2, 95% CI 1.73-15.57), and femoro-popliteal steno-obstructive disease (P=.03, OR 3.06, 95% CI 1.02-9.20) were significantly related to reinterventions during follow-up. Iliac tortuosity ratio and calcification were not a significant predictors of adverse events.
CONCLUSION: This preliminary experience suggests that diameters of access vessels and the presence of femoro-popliteal steno-obstructive disease could affect the outcome of EVAR.

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Sirignano P, Speziale F, Capoccia L, Menna D, Mansour W, Montelione N, et al. Iliac and femoro-popliteal arteries morphological CTA features as determinants of outcome after standard EVAR procedures. J Cardiovasc Surg 2016 Sep 16. 

Corresponding author e-mail

pasqualino.sirignano@uniroma1.it