ORIGINAL ARTICLES   

International Angiology 2002 December;21(4):349-54

Copyright © 2003 EDIZIONI MINERVA MEDICA

lingua: Inglese

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.