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Suitability of the Aortic Neck Anatomy for Endovascular Aneurysm Repair in Korean Patients with Abdominal Aortic Aneurysm

Vascular Specialist International 2020년 36권 2호 p.71 ~ 81
황덕비, 김지혜, 김형기, 허승,
소속 상세정보
황덕비 ( Hwang Deok-Bi ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Surgery
김지혜 ( Kim Ji-Hye ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Surgery
김형기 ( Kim Hyung-Kee ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Surgery
허승 ( Huh Seung ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Surgery

Abstract


Purpose: To evaluate the aortic neck anatomy in Korean patients with abdominal aortic aneurysms (AAAs).

Materials and Methods: We examined computed tomography scans of 343 patients with AAAs (≥5.5 cm for men or ≥5 cm for women) between 2009 and 2018. Eligibility of neck anatomy for endovascular aneurysm repair (EVAR) was assessed with the standard instructions for use (IFU) (length ≥15 mm, suprarenal angulation (SRA) ≤45°, infrarenal angulation (IRA) ≤60°, and diameter 18-32 mm) and the extended IFU (length ≥10 mm, SRA ≤60°, IRA ≤75°, and diameter 17-32 mm).

Results: There were 71 women (20.7%), and 61 patients (17.8%) with rupture. Women had smaller neck diameters (21.3 vs. 23.4 mm, P<0.001 for proximal neck; 22.2 vs. 24.5 mm, P<0.001 for distal neck), and higher angulations (51.5° vs. 37.8°, P<0.001 for SRA; 77.7° vs. 57.0°, P<0.001 for IRA) than men. However, the neck length was not significantly different. Patients with ruptured AAAs had shorter neck lengths (21.0 vs. 26.8 mm, P=0.005) than those with intact AAAs. However, the neck diameters and angulations were not significantly different. EVAR eligibility for standard and extended IFUs was found in 37.5% and 55.1% of men, and 11.3% and 25.4% of women (P<0.001 for both IFUs); neck anatomy was eligible in 34.0% of intact AAAs and 23.0% of ruptured AAAs (P=0.098).

Conclusion: A significant proportion of the Korean patients did not meet the IFU for EVAR, mainly due to the angulated neck. Women, and patients with ruptured AAAs, were less likely to meet the IFU criteria.

키워드

Abdominal aortic aneurysm; Endovascular procedures; Rupture; Sex; Eligibility determination

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