Options to achieve proximal sealing zone during endovascular repair of abdominal aortic aneurysm and correlated classification

Abstract

Since its first development, endovascular aortic aneurysmal repair (EVAR) has largely evolved, and several types of endografts are currently available including bifurcated grafts with supra or infra-renal fixation, fenestrated (FEVAR). Technical advances have led to propose EVAR in patients with challenging anatomy and the indications for using endografts mainly depend on patients’ vascular anatomical characteristics and on the instructions for use. Even if the minimal requirements for standard commercially available endografts have been defined, there is a lack of consensus to help surgeons to choose the most appropriate approach. Here, we propose a four-class abdominal aortic aneurysm (AAA) categorization based on the morphology and the length of the necks considered as landing zones as well as markers of potential evolution of the AAA. This pragmatic classification may help to clarify the decision-making process for selecting the most appropriate endovascular device to treat AAA in accordance with the anatomy and the foreseeable evolution and delayed complication risk to anticipate vascular outcome.