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The Journal of Cardiovascular Surgery 2017 October;58(5):674-9

DOI: 10.23736/S0021-9509.16.08820-0


lingua: Inglese

Validation of pre-procedural aortic aneurysm volume calculations to estimate procedural fill volume of endobags in endovascular aortic sealing

Johannes T. BOERSEN 1, 2 , Leo H. van den HAM 3, Jan M. HEYLIGERS 4, Anco C. VAHL 5, Patrick W. VRIENS 4, Michel M. REIJNEN 3, Jean-Paul P. de VRIES 1

1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; 2 MIRA Institute for Technical Medicine and Biomedical Technology, University of Twente, Enschede, The Netherlands; 3 Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; 4 Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands; 5 Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands


BACKGROUND: Endovascular aortic sealing (EVAS) with a sac anchoring endoprosthesis excludes abdominal aortic aneurysms based on polymer filling of endobags. Primary objective was to assess the reliability of pre-procedural computed tomography (CT) scans based calculations of required endobag volume in relation to intraoperative volume of the endobags.
METHODS: Forty elective EVAS patients were included. Pre-procedural estimations of endobag volume were based on CT segmentations of aortic flow lumen volume, including both automated and manually-adjusted segmentations, performed by two experienced users. Additionally, changes in maximum AAA diameter, thrombus volume and total AAA volume were calculated from pre- and post-procedural CT scans.
RESULTS: Automatically determined volumes were comparable to manually-adjusted calculations (75.3 vs. 75.7 mL) and inter-observer agreement regarding pre-EVAS calculations of prefill volume appeared almost perfect with an intra-class correlation coefficient of 0.98 (95% CI: 0.96-0.99). The mean pressure of the endobags was 185 mmHg. Manually-adjusted pre-procedural volume calculations underestimated procedural volume of the endobags (-11.3±9.9 mL). Differences between pre-EVAS and procedural volume measurements were independent from endobag pressure (r=-0.06, P=0.72), prepocedural thrombus volume (r=-0.303, P=0.057) and changes in total AAA volume (r=0.02, P=0.91). A significant association was determined between differences in pre-EVAS and endobag volume versus changes in thrombus volume pre- and post-procedural (r=0.39, P=0.01).
CONCLUSIONS: In this validation study, pre-procedural volume measurements underestimate the actual fill volume of the endobags. It should be advised to perform a prefill of the endobags during the EVAS procedure.

KEY WORDS: Vascular closure devices - Abdominal aortic aneurysm - Balloon angioplasty

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