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The Journal of Cardiovascular Surgery 2019 June;60(3):375-81

DOI: 10.23736/S0021-9509.16.09509-4


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


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 analyzed. Mean common iliac artery (CIA) diameters calculated in the narrowest point were 12.8±4 mm and 12.9±3.9 mm, and mean external iliac artery (EIA) diameters were 7.7±1.6 mm 7.8±1.7 mm, 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 ≤5 mm (P=0.0012, OR 5.2, 95% CI 1.73-15.57), and femoro-popliteal steno-obstructive disease (P=0.03, OR 3.06, 95% CI 1.02-9.20) were significantly related to reinterventions during follow-up. Iliac tortuosity ratio and calcification were not significant predictors of adverse events.
CONCLUSIONS: This preliminary experience suggests that diameters of access vessels and the presence of femoro-popliteal steno-obstructive disease could affect the outcome of EVAR.

KEY WORDS: Aortic aneurysm, abdominal; Endovascular procedures; Iliac artery; Anatomy

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