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Prediction of aortoiliac stent-graft length: comparison of measurement methods
M Tillich1, B B Hill, D S Paik
1Department of Radiology, Stanford University School of Medicine, S-072B, 300 Pasteur Dr, Stanford, CA 94305-5105, USA.
Insights
The shortest path measurement using helical computed tomography (CT) accurately predicts aortoiliac stent-graft length. This method is more precise than other CT angiography and intravascular ultrasonographic withdrawal techniques for endovascular aneurysm repair.
Area of Science:
- Vascular surgery
- Medical imaging
- Endovascular repair
Background:
- Accurate stent-graft length prediction is crucial for successful endovascular repair of abdominal aortic aneurysms.
- Traditional measurement methods may not fully account for complex arterial anatomy.
Purpose of the Study:
- To evaluate the accuracy of helical computed tomography (CT), CT angiography, and intravascular ultrasonographic withdrawal (IUW) for predicting aortoiliac stent-graft length.
Main Methods:
- Helical CT data from 33 patients were analyzed before and after endovascular repair.
- Calculated aortoiliac lengths using the shortest path (SP) and median luminal centerline (MLC).
- Compared predeployment measurements with postdeployment lengths.
Main Results:
- The shortest path (SP) measurement demonstrated the lowest mean error (-2.1 mm +/- 4.6) in predicting postprocedural aortoiliac length.
- SP was significantly more accurate than MLC, projected MLC, and IUW (P <.001).
Conclusions:
- The shortest aortoiliac path length, maintaining a radius distance from the vessel wall, is the most accurate method for predicting stent-graft length.
- This finding supports the use of SP measurements for improved planning in aortoiliac stent-graft procedures.
Purpose:
To determine the accuracy of helical computed tomography (CT), projectional angiography derived from CT angiography, and intravascular ultrasonographic withdrawal (IUW) length measurements for predicting appropriate aortoiliac stent-graft length.
Materials And Methods:
Helical CT data from 33 patients were analyzed before and after endovascular repair of abdominal aortic aneurysm (Aneuryx graft, n = 31; Excluder graft, n = 2). The aortoiliac length of the median luminal centerline (MLC) and the shortest path (SP) that remained at least one common iliac arterial radius away from the vessel wall were calculated. Conventional angiographic measurements were simulated from CT data as the length of the three-dimensional MLC projected onto four standard viewing planes. These predeployment lengths and IUW length, available in 24 patients, were compared with the aortoiliac arterial length after stent-graft deployment.
Results:
The mean error values of SP, MLC, the maximum projected MLC, and IUW were -2.1 mm +/- 4.6 (SD) (P =.013), 9.8 mm +/- 6.8 (P <.001), -5.2 mm +/- 7.8 (P <.001), and -14.1 mm +/- 9.3 (P <.001), respectively. The preprocedural prediction of the postprocedural aortoiliac length with the SP was significantly more accurate than that with the MLC (P <.001), maximum projected MLC (P <.001), and IUW (P <.001).
Conclusion:
The shortest aortoiliac path length maintaining at least one radius distance from the vessel wall most accurately enabled stent-graft length prediction for 31 AneuRx and two Excluder stent-grafts.