Suitability of Ruptured AAA for Endovascular Repair

Abstract

Purpose:

To determine the anatomical suitability and the range of endografts required to undertake an endovascular repair (EVR) program for ruptured abdominal aortic aneurysms.

Methods:

The morphology of ruptured and nonruptured AAAs were compared by retrospective review of computed tomographic scans from 51 patients (47 men; mean age 76 years, range 55–90) with ruptured AAAs and 50 patients (37 men; mean age 74 years, range 57–75) with nonruptured AAAs. Three experienced clinicians reviewed the scans for EVR suitability based on a generic trimodular endograft with suprarenal fixation. Endograft oversizing was assumed to be 10% to 20%.

Results:

Interobserver agreement was high, with a mean kappa of 0.78 (range 0.75–0.83, p<0.001). In all, 41% of ruptured and 68% of nonruptured AAAs were suitable for EVR (p=0.009). Ruptured AAAs had shorter mean neck lengths (17±12 versus 22±11 mm, p=0.031) and larger mean aneurysm diameters (75±15 versus 63±9 mm, p>0.001). Neck length and neck diameter were significantly correlated for ruptured AAAs (r=–0.34, p= 0.018). The main contraindication to EVR was hostile neck morphology. A range of endografts with aortic components from 24 to 32 mm and iliac components from 12 to 22 mm would be required to stent 41% of ruptured AAAs.

Conclusions:

Ruptured AAAs are less suitable for EVR due to differing neck morphology. An EVR program for ruptured AAA requires an inventory of endografts with appropriate aortic and iliac components.