COMPUTED TOMOGRAPHIC ANGIOGRAPHIC IMAGING OF ABDOMINAL AORTIC-ANEURYSMS - IMPLICATIONS FOR TRANSFEMORAL ENDOVASCULAR ANEURYSM MANAGEMENT

Purpose: To describe anatomic features pertinent to patient selection and graft design for transfemoral endovascular aneurysm management (TE AM) of the infrarenal aorta using computed tomographic (CT) angiograph y. Methods: A prospective noncomparative analysis of 102 spiral CT sca ns of the abdominal aorta of patients with abdominal aortic aneurysms was performed. From the original CT data set, slices were reconstructe d perpendicular to the vessel axis (central lumen line) at a 10 mm int erval. In these reconstructed slices, diameter measurements were perfo rmed. Vessel length was measured along the central lumen line. In each patient possibilities for TEAM were analyzed. Results: Because of tec hnical reasons, 36 scans were excluded from the analysis. Of the remai ning 66 patients, 18 could potentially be treated with a bifurcated en dovascular device. The infrarenal aortic diameter-to-iliac artery diam eter ratio was less than 2 in most patients. The vessel segments judge d to be adequate for endovascular graft anchoring had a noncylindrical shape in the majority of cases. Conclusion: Only a minority of patien ts with abdominal aortic aneurysms can at this stage be treated with a n endovascular graft, The ideal endovascular graft should be a combina tion of rigid and flexible components, The proximal and distal attachm ent systems should have some flexibility with an intrinsic maximum dia meter while the midsection of the graft can be relatively rigid.