The phenomenon of stentgraft “shortening” during endovascular stentgraft implantation into an abdominal aortic aneurysm in cases involving significant tortuosity of the aorta and iliac arteries.

Abstract

Introduction: One of the main problems with the implantation of stent-graft (STG) in the abdominal aortic aneurysm (AAA) remains its proper fit. Minor differences in distances from the relevant structures can result in life-threatening complications. This article aims to show the problem of aortic stent-graft shortening during implantation. This occurs in the case of significant tortuosity of the abdominal aorta vessels and iliac arteries. Our study has found a significant correlation between vessel tortuosity and erroneous results of preoperative sizing (using the centerline). The new measurement system developed (along long curves) seems to correlate better with intraoperative images. Material and methods: The study involved the evaluation of 70 patients sized classically and with the use of the described technique, and then operated on with the EVAR technique. In all patients, stent-grafts were sized classically (using the central lumen line) and along the curvature line of the sized vessels. The dimensions of the stent-graft were selected according to the standard method (classical sizing), and the fit of the STG in relation to the calibrated catheter (“pigtail”), and the final postoperative result was considered to be the final result. There were 44 men (62,8%) and 26 women (37,2 %) in the study group. The mean age of patients was 74 years. Eighty-nine percent of patients were classified as NYHA (Class I-II) and 11 % of patients as NYHA Class III. Results: Average measurement of the aorta and iliac arteries using the centerline was 201.8 mm, and average measurement based on the curvature of vessels was 222.2 mm. Average measurement using calibrated catheter was 218.1 mm. The results of the analysis showed significant differences between the measurements (centerline and long curvature of vessel): Z = 7.17; p < 0.001; r = 0.87. Conclusions: The measurement made along the long curves is more accurate than the measurement made with the centerline. The measurement made with the centerline is underestimated (it indicates a smaller value than the actual measurement).