Endovascular repair of abdominal aortic aneurysm without preoperative arteriography

• Published in: Journal of vascular surgery 2003-10, Vol.38 (4), p.730-738
• Main Authors: Wyers, Mark C, Fillinger, Mark F, Schermerhorn, Marc L, Powell, Richard J, Rzucidlo, Eva M, Walsh, Daniel B, Zwolak, Robert M, Cronenwett, Jack L
• Format: Article
• Language: English
• Subjects: Aged; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortography; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the aorta; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Medical sciences; Preoperative Care; Software; Stents; Tomography, Spiral Computed
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/S0741-5214(03)00552-4

Clinical trials of endovascular aortic aneurysm repair (EVAR) have required both preoperative aortography and computed tomography (CT). We codeveloped specialized three-dimensional (3-D) reconstruction and computer-aided measurement, planning, and simulation software (3-D CAMPS) based on CT or magnetic resonance imaging, to eliminate the need for preoperative arteriography. EVAR with 3-D CAMPS as the sole preoperative imaging method was performed in 196 patients from 1996 to 2001, with six endograft types in three configurations. Physical examination, abdominal radiography, and CT (3D-CAMPS) were performed at 1, 6, and 12 months, then annually. For a subset of cases in which a comparison could be made, 3-D CAMPS was superior to angiography for prediction of endograft length and iliac access. Hospital mortality was zero, and 30-day mortality was 0.5%. In three patients immediate conversion to open repair (1.5%) was necessary because of previously unknown stent-graft mechanical limits. Incidence of endoleak was 15% at 1 month, 10% at 6 months, 6% at 12 months, and 7% at 24 months, and 92% of endoleaks were type II. Mean follow-up was 18 months. Aneurysm-related mortality was zero. Nineteen secondary procedures (all endovascular) were performed in 16 patients (8%). For all graft types, freedom from secondary procedure was 94% at 1 year and 90% at 2 years, and this was better for endografts ultimately approved by the US Food and Drug Administration (96% at 1 year, 95% at 2 years; P = .02). No known measurement-related complications occurred in the series. Results for secondary intervention and endoleak compare favorably to series with similar endograft types. EVAR can be performed with 3-D CAMPS as the sole preoperative imaging method to achieve outcomes comparable to the best series published for each endograft type. CT with 3-D CAMPS can effectively eliminate the need for preoperative arteriography and avert associated morbidity, expense, and exposure to contrast agent and radiation.