Endovascular repair of abdominal aortic aneurysm using the EVT device: Limited increased utilization with availability of a bifurcated graft

Purpose: To determine if the availability of a bifurcated graft would incre ase the percentage of patients eligible for endovascular repair of abdomina l aortic aneurysms (AAAs). Methods: One hundred eighty-five consecutive patients were evaluated prospe ctively for endovascular AAA repair at a university referral center. Data w ere collected on eligibility for tube or bifurcated endovascular grafts, re asons for exclusion, aneurysm morphology, and the interventions performed. Results: Forty-six (25%) patients were eligible for endovascular treatment using the first-generation Endovascular Technologies (EVT) system: 19 (10%) for a tube graft and 27 (15%) for a bifurcated device. An unsuitable proxi mal neck was the reason for exclusion in 48% of patients (excess diameter i n 27%, inadequate length in 21%). Unsuitable iliac configuration was presen t in 41% of those excluded; 29% of the common iliac arteries were enlarged or aneurysmal, while 12% were small or tortuous. Conclusions: Although a bifurcated graft more than doubles the eligibility of AAA patients for endovascular repair, the configuration of the proximal neck and iliac disease excluded the majority of AAA patients from endovascu lar therapy using the first generation EVT device.