PREOPERATIVE SIZING OF GRAFTS FOR TRANSFEMORAL ENDOVASCULAR ANEURYSM MANAGEMENT - A PROSPECTIVE COMPARATIVE-STUDY OF SPIRAL CT ANGIOGRAPHY,ARTERIOGRAPHY, AND CONVENTIONAL CT IMAGING

Purpose: To define the impact of spiral computed tomographic angiograp hy (CTA) with image reconstruction an graft selection for Transfemoral Endovascular Aneurysm Management (TEAM) by comparing it to convention al computed tomography (CT) and contrast arteriography. Methods: Twent y-one candidates for TEAM were included. The diameters of the superior and inferior aneurysm necks and lengths between the graft attachment sites were measured using the three imaging techniques. These measurem ents and their consequences on graft selection were studied. Results: The difference in length sizing between spiral CTA and arteriography n ever exceeded 1 cm; however, lengths measured by conventional CT scann ing resulted in underestimation of graft length in 91% of patients. Gr aft diameters were chosen too small in 62% of the patients when based on arteriographic diameter measurements. A graft of similar diameter w as selected by spiral CTA and conventional CT scanning in 81% of the p atients, while minor oversizing by conventional CT scanning was found in 14T%. Conclusions: Neither conventional CT scanning nor arteriograp hy is adequate as a sole preoperative radiological investigation for T EAM graft sizing. Spiral CTA with image processing produces all inform ation required for selection of the optimal graft size and should be r egarded the method of first choice for this purpose.