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Sizing Fenestrated Aortic Stent-grafts

Malkawi, A. H.; Resch, Tim LU ; Bown, M. J.; Manning, B. J.; Poloniecki, J. D.; Nordon, I. M.; Loftus, I. M.; Thompson, M. M. and Hinchliffe, R. J. (2011) In European Journal of Vascular and Endovascular Surgery 41(3). p.311-316
Abstract
Introduction: Fenestrated aortic stent-grafts are increasingly being used to treat patients with juxtarenal abdominal aortic aneurysms (AM). Sizing of these stent-grafts is critical to ensure success and requires detailed expert assessment of aortic morphology. At present little is known about how sizing of these stent-grafts varies between observers and the necessary tolerances involved to ensure a successful procedure. Methods: CT scans of 19 consecutive patients with juxtarenal aortic aneurysms that underwent successful endovascular repair with fenestrated stent-grafts were selected. Sizing of fenestrated aortic stent-grafts was performed independently by four experienced endovascular surgeons and results were compared. Data from the... (More)
Introduction: Fenestrated aortic stent-grafts are increasingly being used to treat patients with juxtarenal abdominal aortic aneurysms (AM). Sizing of these stent-grafts is critical to ensure success and requires detailed expert assessment of aortic morphology. At present little is known about how sizing of these stent-grafts varies between observers and the necessary tolerances involved to ensure a successful procedure. Methods: CT scans of 19 consecutive patients with juxtarenal aortic aneurysms that underwent successful endovascular repair with fenestrated stent-grafts were selected. Sizing of fenestrated aortic stent-grafts was performed independently by four experienced endovascular surgeons and results were compared. Data from the stent-graft manufacturer was available for comparison in 12 cases. Results: All observers agreed on the number of fenestrations; 16 devices had 3 fenestrations and 3 had 4. The overall inter-observer measurement error for all target vessel orientation was +/- 12.6 degrees (10.8-14.4 95% CI), and for distance between target vessels +/- 5.3 mm (4.4-6.2 95% CI). The median difference in internal stent-graft diameter was 1 stent size. Agreement on fenestration type ranged from (84-95%). Comparison was performed with the manufactured stent-graft in 12 cases. The overall mean difference of target vessel orientation between the manufactured devices and the four observers was -1.3 degrees (SD +/- 6.9, -3.8-1.2 95% CI). There was less agreement between observers and device manufacturers on body and limb lengths and distal limb diameters. Conclusions: There was generally a high level of agreement between experienced endovascular surgeons in sizing the fenestrated stent component. There were differences in component lengths but these could have been accommodated by varying the degree of overlap between components. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Fenestrated EVAR, EVAR, AAA, Aortic aneurysm
in
European Journal of Vascular and Endovascular Surgery
volume
41
issue
3
pages
311 - 316
publisher
Elsevier
external identifiers
  • wos:000288728400002
  • scopus:79951771263
ISSN
1532-2165
DOI
10.1016/j.ejvs.2010.10.008
language
English
LU publication?
yes
id
83dd7ee2-96f2-4f90-94e9-3619873e1e40 (old id 1926048)
date added to LUP
2011-05-02 08:41:51
date last changed
2017-07-30 04:24:56
@article{83dd7ee2-96f2-4f90-94e9-3619873e1e40,
  abstract     = {Introduction: Fenestrated aortic stent-grafts are increasingly being used to treat patients with juxtarenal abdominal aortic aneurysms (AM). Sizing of these stent-grafts is critical to ensure success and requires detailed expert assessment of aortic morphology. At present little is known about how sizing of these stent-grafts varies between observers and the necessary tolerances involved to ensure a successful procedure. Methods: CT scans of 19 consecutive patients with juxtarenal aortic aneurysms that underwent successful endovascular repair with fenestrated stent-grafts were selected. Sizing of fenestrated aortic stent-grafts was performed independently by four experienced endovascular surgeons and results were compared. Data from the stent-graft manufacturer was available for comparison in 12 cases. Results: All observers agreed on the number of fenestrations; 16 devices had 3 fenestrations and 3 had 4. The overall inter-observer measurement error for all target vessel orientation was +/- 12.6 degrees (10.8-14.4 95% CI), and for distance between target vessels +/- 5.3 mm (4.4-6.2 95% CI). The median difference in internal stent-graft diameter was 1 stent size. Agreement on fenestration type ranged from (84-95%). Comparison was performed with the manufactured stent-graft in 12 cases. The overall mean difference of target vessel orientation between the manufactured devices and the four observers was -1.3 degrees (SD +/- 6.9, -3.8-1.2 95% CI). There was less agreement between observers and device manufacturers on body and limb lengths and distal limb diameters. Conclusions: There was generally a high level of agreement between experienced endovascular surgeons in sizing the fenestrated stent component. There were differences in component lengths but these could have been accommodated by varying the degree of overlap between components. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.},
  author       = {Malkawi, A. H. and Resch, Tim and Bown, M. J. and Manning, B. J. and Poloniecki, J. D. and Nordon, I. M. and Loftus, I. M. and Thompson, M. M. and Hinchliffe, R. J.},
  issn         = {1532-2165},
  keyword      = {Fenestrated EVAR,EVAR,AAA,Aortic aneurysm},
  language     = {eng},
  number       = {3},
  pages        = {311--316},
  publisher    = {Elsevier},
  series       = {European Journal of Vascular and Endovascular Surgery},
  title        = {Sizing Fenestrated Aortic Stent-grafts},
  url          = {http://dx.doi.org/10.1016/j.ejvs.2010.10.008},
  volume       = {41},
  year         = {2011},
}