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Aortic-neck dilation after endovascular abdominal aortic aneurysm repair (EVAR): can it be predicted?

È possibile predire la dilatazione del colletto prossimale dell’aneurisma dell’aorta addominale dopo trattamento endovascolare (EVAR)?

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study was performed to evaluate whether dynamic computed tomography (CT) can provide functional vessel information predicting outcomes of aortic neck in patients undergoing endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA).

Materials and methods

Twenty patients with and 20 without AAA were enrolled. Electrocardiographically (ECG)-gated data sets were acquired with a 64-slice CT scanner. Axial pulsatility measurements were taken at three levels: 2 cm above the highest renal artery; immediately below the lowest renal artery; 1 cm below the lowest renal artery. Three independent readers performed the measurements. Systolic and diastolic blood pressures were measured in the brachial artery to calculate arterial-wall distensibility expressed as pressure strain elastic modulus (Ep). Cross-sectional area change, wall distensibility and Ep value were statistically compared.

Results

No significant differences were found in terms of Ep values in the suprarenal and juxtarenal level. In the AAA group, a significantly higher value was obtained at the infrarenal level. A subgroup of patients with AAA (45%) had a significantly higher Ep value at the infrarenal level.

Conclusions

Dynamic CT provided insight into the abdominal aorta pathophysiology. Identifying patients with higher infrarenal distensibility could change selection of graft size to improve proximal fixation.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare se l’angio-tomografia computerizzata (TC) dinamica possa fornire informazioni in grado di predire l’outcome del colletto aortico in pazienti sottoposti a trattamento endovascolare (EVAR) dell’aneurisma dell’aorta addominale (AAA).

Materiali e metodi

Venti pazienti con AAA e 20 pazienti senza AAA sono stati sottoposti ad angio-TC dinamica (64 strati) con gating cardiaco. Le misurazioni della pulsatilità aortica sono state effettuate da tre lettori indipendenti: 2 cm sopra l’arteria renale più craniale; immediatamente al di sotto dell’arteria renale più caudale; 1 cm al di sotto dell’arteria renale più caudale. Sono state misurate le pressioni arteriose brachiali sistolica e diastolica al fine di valutare il grado di distensibilità della parete aortica, espresso come modulo pressorio di deformazione elastica (Ep). Sono state confrontate in termini statistici la pulsatilità aortica, la distensibilità di parete e l’Ep.

Risultati

Non si sono riscontrate differenze statisticamente significative nel valore di Ep nel tratto sovra- ed iuxtarenale. Nel gruppo di pazienti con AAA si è riscontrato un valore di Ep maggiore nel tratto infrarenale. In un sottogruppo di pazienti con AAA (45%) si è riscontrato un valore di Ep nel tratto infrarenale significativamente più elevato.

Conclusioni

L’angio-TC dinamica sembra fornire informazioni sulla fisiopatologia dell’aorta addominale. L’identificazione di pazienti con maggior distensibilità dell’aorta sottorenale potrebbe modificare la scelta del calibro dell’endoprotesi.

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Authors and Affiliations

  1. Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy

    R. Iezzi, M. Santoro, G. Di Natale, F. Pirro, R. Dattesi, M. Nestola & L. Bonomo

  2. Department of Vascular Surgery, “A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy

    F. Snider

Authors
  1. R. Iezzi
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  2. M. Santoro
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  3. G. Di Natale
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  4. F. Pirro
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  5. R. Dattesi
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  6. M. Nestola
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  7. F. Snider
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  8. L. Bonomo
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Correspondence to R. Iezzi.

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Iezzi, R., Santoro, M., Di Natale, G. et al. Aortic-neck dilation after endovascular abdominal aortic aneurysm repair (EVAR): can it be predicted?. Radiol med 117, 804–814 (2012). https://doi.org/10.1007/s11547-011-0750-1

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  • DOI: https://doi.org/10.1007/s11547-011-0750-1

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