THE ANATOMY OF ABDOMINAL AORTIC-ANEURYSMS - IMPLICATIONS FOR SIZING OF ENDOVASCULAR GRAFTS

Objectives: To determine the full range of aorto-iliac anatomy of pati ents with abdominal aortic aneurysms (AAAs) and thence the range of en dovascular graft sizes required to deal with the majority of AAAs. Des ign: Analysis of preoperative spiral CT measurements Materials: One hu ndred and sixty-eight patients with AAAs Method: Multiplanar reconstru ction measurements were taken of proximal aortic neck diameter and len gth, lowermost renal artery to the aortic bifurcation distance and len gth and diameter of common iliac arteries. Based on these measurements a range of graft sizes that would fit the majority of AAAs was determ ined. Results: Ranges of anatomical variables were as follows: proxima l aortic neck diameter 18-30 mm, renal artery to aortic bifurcation di stance 93-210 mm, common iliac artery length 13-108 mm, common iliac a rtery diameter 6-67 mm. Over 750 graft sizes would be required to cove r all anatomical combinations using a one-piece aorto-uni-iliac graft. Conclusion: A wide variety of aorto-iliac anatomy exists in patients with AAAs. The large number of graft sizes required to deal with the m ajority of AAAs makes the production of one-piece endovascular grafts commercially impractical. A proposed two-piece modular graft would all ow the majority of AAAs to be treated using only 16 graft sizes.