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Anatomic Eligibility For Endovascular Aneurysm Repair Preserved Over Two Years Of Surveillance
Brooks L. Rademacher, MD, Annalise M. Panthofer, BS, Sydney L. Olson, BS, Jon S. Matsumura, MD.
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

OBJECTIVES: Endovascular aneurysm repair (EVAR) is a popular option for patients with suitable anatomy who have a large infrarenal abdominal aortic aneurysm (AAA). Patients with small AAA who are managed with careful surveillance are frequently concerned that their anatomy may change with AAA growth, and their option for EVAR may become limited. Device innovation has resulted in expanded ranges of anatomy that may be eligible for EVAR. This study sought to define the anatomic eligibility of AAA patients with contemporary devices, monitored by CT over the course of 2 years.
 
METHODS: 181 subjects from the NTA3CT trial (NCT01756833) were included in this analysis if they completed pre-enrollment and 24-month or later CT imaging. 20 were female with baseline AAA maximal transverse diameter (MTD) between 3.5-4.5 cm, and 161 were male and with baseline MTD between 3.5-5.0 cm. Pertinent anatomic measurements were performed on a post-processing workstation in a centralized imaging core laboratory. EVAR candidacy was primarily determined by proximal aortic neck diameter, length anatomy, and iliac diameter, and patients were considered EVAR-eligible if they qualified for at least one of the more commonly used devicesí Instructions For Use. Paired t-test analysis was used to detect differences in aortic measurements.
 
RESULTS: 91.7% of patients were eligible for EVAR at baseline and 88.4% at follow up. Mean selected diameters, lengths, and angles are provided in the table.
  

EVAR EligibleNeck length (mean +/- SEM)Neck diameter at renal (mean +/- SEM)Neck diameter 5 mm below renal (mean +/- SEM)Neck diameter 10 mm below renal (mean +/- SEM)Neck diameter 15 mm below renal (mean +/- SEM)Suprarenal aortic angle (mean +/- SEM)Infrarenal aortic angle (mean +/- SEM)
Baseline166/181 (91.7%)36.1 +/- 1.2mm24.2 +/- 0.2mm24.0 +/- 0.2mm24.2 +/- 0.2mm24.7 +/- 0.2mm12.3 +/- 0.7 deg20.0 +/- 1.0 deg
2 years+160/181 (88.4%)35.2 +/- 1.2mm23.9 +/- 0.2mm24.0 +/- 0.2mm24.4 +/- 0.3mm25.0 +/- 0.3mm13.8 +/- 0.8 deg21.1 +/- 1.0 deg
P =0.010.030.800.230.030.0080.10

CONCLUSIONS: The vast majority of patients eligible for EVAR when entering a surveillance program for small AAA remain eligible after two years. Substantial changes in neck anatomy to warrant concern for loss of EVAR treatment options are rare. The few patients with progression remain candidates for complex EVAR and open repair.


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