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Rivista di Angiologia
Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 2002 December;21(4):349-54
Aortoiliac angulation and the need for secondary procedures to secure stent graft fixation: which angle is important?
Filis K. A. 1, Arko F. R. 1, Rubin G. D. 2, Raman B. 2, Fogarty T. J. 1, Zarins C. K. 1
1 Division of Vascular Surgery, Stanford University Hospital, Stanford, CA, USA
2 Department of Radiology, Stanford University Hospital, Stanford, CA, USA
Background. The purpose of this study was to quantify the degree of aortoiliac tortuosity and determine the relationship between aortoiliac angulation and the need for a secondary procedure following endovascular repair.
Methods. Among 206 patients treated with the AneuRx stent graft, 3-year follow up data were available in 71 patients. Twenty eight patients without duplex and CT angiograms (CT angiography) on follow-up were excluded. The anatomy of the preoperative proximal aortic neck was evaluated using 3D-CT angiography reconstructed images in: a) Group I: 15 patients who required secondary procedures and b) Group II: 18 patients without any endovascular leak during follow up. The groups did not differ in age (72.9±6.1 versus 73.3±9.1) or aneurysm diameter (60.1±9.1 versus 60.5±10.1). In order to determine the aortoiliac tortuosity, we measured: a) the suprarenal aorta-infrarenal aortic neck angle: angle of the aorta at the level of the renal arteries, b) infrarenal aortic neck-aneurysm angle: angle of the aorta at the start of aneurysm, c) right iliac angle, d) left iliac angle, e) aortic neck length, f) aortic neck diameter.
Results. Computer-based measurements on 3D-CT angiography reconstructed images were: a) suprarenal aorta-infrarenal aortic neck angle: group I: (22.6±16.2), group II: (11.9±6.9), p<0.05; b) infrarenal aortic neck-aneurysm angle: group I: 17.6±12.4, group II: 18.8±9.4, p=NS; c) right iliac angle: group I: 22.9±12.6, group II: 20.4±9.5, p=NS; d) left iliac angle: group I: 22.4±10.5, group II: 19.1±12.2, p=NS; e) aortic neck length: group I: 18.9±5.3 mm, group II: 20.4±5.3 mm, p=NS; f) aortic neck diameter: group I: 24.1±1.0 mm, group II: 23.3±1.6, p=NS.
Conclusions. Aortoiliac angulation can be defined and quantified. In patients requiring secondary procedures, there is an increased angulation at the proximal aortic neck angle.