Effects Of Iliac Tortuosity Index On Fenestrated Endovascular Aortic Repair For Pararenal And Thoracoabdominal Aortic Aneurysms
Lia Jordano, MD, Emilie C. Robinson, MD, Ross Garberich, Aleem Mirza, MD, Jesse Manunga, MD.
Abbott Northwestern Hospital, Minneapolis, MN, USA.
OBJECTIVES To evaluate the effect of iliac tortuosity on procedural metrics and outcomes during FEVAR. METHODS The study is a retrospective review of a prospectively maintained database of patients undergoing fenestrated/branched endovascular aortic aneurysm repair (f/b-EVAR) between the years 2013 and 2020 at our institution. Included patients had at least one preoperative computed tomography angiography (CTA) available for analysis. Patients without preoperative CTA were excluded from the study. Iliac tortuosity index (TI) was calculated using centerline flow imaging from a three dimensional work station based the formula: (centerline iliac length/straight-line iliac length). The presence of previous infrarenal endovascular aortic repair (EVAR) was also recorded. The effects of iliac tortuosity on procedural metrics including total operative time, fluoroscopy time, radiation dose, and contrast volume were evaluated. RESULTS During this period, 219 patients underwent f/b-EVAR at our institution. Ninety-two patients (73% male; mean age 75.2 ± 7.7 years) who underwent FEVAR during the study period met inclusion criteria into the study. In this group, there were 74 (80%) juxtarenal/pararenal or paravisceral aneurysms and 18 (20%) thoracoabdominal aortic aneurysms. The average aneurysm diameter was 60.1 ± 0.74mm. A mean of 2.9 ± 0.9 vessels were incorporated per patient. Five patients (5.4%) had failed previous EVAR. The mean total operative time was 236 ± 83min, fluoroscopy time was 87 ± 39min, contrast volume was 81 ± 47mL, radiation dose 3246 ± 2207mGy, and estimated blood loss (EBL) was 290 ± 409mL. The average left and right TIs for all patients were 1.5 ± 0.3 and 1.4 ± 0.3, respectively. There was no association of TI with procedural metrics or EBL (Table 1). CONCLUSIONS There was no association of tortuosity index with any procedural metric or estimated blood loss. Iliac tortuosity may demonstrate an effect on these metrics if evaluated in a larger cohort and should still be considered during preoperative planning.
| Association Coefficient | Association Coefficient | |
| Right Tortuosity Index | Left Tortuosity Index | |
| Estimated Blood Loss | 0.186 | 0.227 |
| OR Time | 0.088 | 0.072 |
| Contrast | 0.148 | 0.053 |
| Radiation Dose | 0.025 | -0.017 |
| Fluoroscopy Time | 0.162 | 0.103 |
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