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 PS36. Abdominal Aortic Bifurcation Anatomy and Endograft Limbs’ Size Affect the Use of Adjunctive Iliac Stenting During Endovascular Abdominal Aortic Aneurysm Repair

​Claudio Bianchini Massoni1, Mauro Gargiulo1, Antonio Freyrie1, Enrico Gallitto1, Federica Giovanetti1, Joseph J. Ricotta2, Andrea Stella1
1Vascular Surgery, University of Bologna, Bologna, Italy; 2Vascular Surgery, Emory University, Atlanta, GA.

OBJECTIVES: Post-angioplasty residual stenosis >50% (PRS) of iliac endograft limb after endovascular abdominal aneurysm repair (EVAR) is an indication for intra-operative adjunctive stenting. The aim of the study is to determinate if abdominal aortic bifurcation diameter (AB), ratio of sum of iliac limb diameters to aortic bifurcation diameter (IL/AB) and aortic bifurcation calcification influence the PRS

METHODS: Post-angioplasty residual stenosis >50% (PRS) of iliac endograft limb after endovascular abdominal aneurysm repair (EVAR) is an indication for intra-operative adjunctive stenting. The aim of the study is to determinate if abdominal aortic bifurcation diameter (AB), ratio of sum of iliac limb diameters to aortic bifurcation diameter (IL/AB) and aortic bifurcation calcification influence the PRS

RESULTS: Two hundred forty-seven patients (233 men; mean age 74±7 years) with 494 endograft limbs were evaluated. Mean AB was 28.9 mm ± 12.9 mm. Median endograft iliac leg diameter was 16 mm. AB was≤20 mm in 70 patients (28%), IL/AB was >1.4 in 35%, AB≤20 mm associated with IL/AB>1.4 in 22% and aortic bifurcation calcification ≥25% in 61% of patients.
Thirty-six (15%) aortic bifurcations developed PRS and were treated with adjunctive stenting. In this group, AB was ≤ 20 mm in 42%, IL/AB >1.4 in 56%, AB≤ 20 mm associated with IL/AB>1.4 in 36% and aortic bifurcation calcification ≥25% in 67% of patients. The mean follow up was 36 months (range 6-65 months).Multivariate analysis identified AB ≤20 mm, IL/AB>1.4 and IL/AB>1.4 associated with calcification ≥ 25% as predictive factors for PRS (p=0.05, p=0.007 and p=0.015 respectively). Technical success and mid-term (36 months) clinical success were 100%

CONCLUSIONS: PRS of iliac endograft is a common pattern in the EVAR. AB ≤20 mm, ILs/AB >1.4 and aortic bifurcation calcification ≥25% associated with ILs/AB>1.4 are statistically correlated with PRS. Adjunctive stenting is a safe procedure and ensures patency in patients with PRS

AUTHOR DISCLOSURES: C. Bianchini Massoni, Nothing to disclose; A. Freyrie, Nothing to disclose; E. Gallitto, Nothing to disclose; M. Gargiulo, Nothing to disclose; F. Giovanetti, Nothing to disclose; J. J. Ricotta, Nothing to disclose; A. Stella, Nothing to disclose.

Posted April 2012

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