Morphometry and classification in abdominal aortic aneurysms: patient selection for endovascular and open surgery

Area of Science:

• Vascular Surgery
• Medical Imaging
• Biomedical Engineering

Background:

• Abdominal aortic aneurysms (AAAs) pose significant risks, necessitating effective treatment strategies.
• Endovascular graft (EVG) repair offers a less invasive alternative to open surgery for AAAs.
• Accurate patient selection is crucial for successful EVG outcomes.

Purpose of the Study:

• To evaluate the anatomic morphology of abdominal aortic aneurysms (AAAs).
• To develop a classification system for AAAs to guide patient selection for EVG repair.
• To identify morphological criteria predictive of successful EVG repair.

Main Methods:

• Prospective data collection from 242 consecutive AAA patients over 3.5 years.
• Utilized intravenous spiral computed tomographic angiography and intraarterial digital subtraction angiography.
• Analyzed diameters, lengths, tortuosity, and occlusive disease of the aorta and iliac arteries.

Main Results:

• Developed a three-type AAA classification based on aneurysm extent.
• Identified 51.7% of patients as potential EVG candidates based on morphology alone.
• Only 30.2% were deemed suitable for secure EVG repair considering all relevant vascular factors.

Conclusions:

• Detailed preoperative measurements are essential for EVG planning.
• Liberal EVG indications may increase complication rates.
• Restrictive, morphology-based selection criteria are recommended for optimal EVG results.