Society For Clinical Vascular Surgery

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Assessment of Anatomic Changes Over Time in Aortic Aneurysms: Is a 6 to 12-month-old Computed Tomography Angiography Scan Adequate for Planning Fenestrated/Branched Endovascular Aneurysm Repair?
Tammy T. Nguyen, MD, PhD, Jessica P. Simons, MD, MPH, Sourav Podder, BS, Allison S. Wyman, MS, Dejah R. Judelson, MD, Edward J. Arous, MD, MPH, Francesco A. Aiello, MD, Andres Schanzer, MD
University of Massachusetts, Worcester, MA

Objectives: Fenestrated/branched EVAR (F/BEVAR) success depends on precise preoperative planning from anatomic measurements made on CT-angiogram (CTA). Patients referred for F/BEVAR often present with a previous CTA, but it is unknown how recent the CTA must be to ensure accurate F/BEVAR planning. We sought to determine if key anatomic planning parameters change significantly between a CTA used for F/BEVAR planning and a CTA obtained 6 to 12 months prior. Methods: Two blinded, independent, observers reviewed preoperative CTAs from 21 patients who underwent F/BEVAR. Each patient had two CTA scans, a “recent” scan obtained 0-6 months for F/BEVAR planning and a “prior” scan obtained 6 to 12 months before the “recent” CTA scan. Each pair of “recent”/”prior” CTAs was assessed using 3-dimensional centerline software (Terarecon, Redding, CA). Standard measurements included: 1) target vessel separation distances, 2) target vessel origin clock position, 3) aortic diameter at 1cm intervals over 3cm of the defined proximal seal zone (PSZ), and 4) proximal F/BEVAR device diameter. Clinically significant differences for target vessel separation distance, target vessel origin clock position, aortic diameter, and proximal F/BEVAR device diameter were >5mm, >30 minutes, >3mm, and >4mm, respectively. Differences between “recent”/“prior” CTA scans were examined by paired t-test. Results: Mean time interval between paired “recent”/“prior” CTAs was 8.0 months (SD±1.7). Mean difference in “recent” versus “prior” target vessel distance (relative to celiac artery, CA) was 1.0mm for superior mesenteric artery (SMA, p=0.21), 0.2mm for right renal artery (RRA, p=0.81), and 1.6mm for left renal artery (LRA, p=0.29). Target vessel clock position (SMA reference at 12:00) varied by 11 minutes for CA (p<0.001), 12 minutes for RRA (p<0.0001), and 14 minutes for LRA (p<0.001). Aortic diameter mean difference at 1cm, 2cm, and 3cm below the PSZ was 0.4mm, 0.0mm, and 0.4mm, (p= 0.41, p=0.99, p=0.55), respectively. F/BEVAR device diameter mean difference was 0.8mm (p=0.13). Conclusions: In patients who underwent successful F/BEVAR, measurement comparisons between “recent”/“prior” CTAs were minor, and unlikely to yield clinically significant changes to F/BEVAR design. While the optimal timing of CTA relative to F/BEVAR planning remains unknown, our findings suggest that those obtained up to one-year prior are adequate.


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