J Korean Med Sci.  2008 Aug;23(4):651-656. 10.3346/jkms.2008.23.4.651.

Limited Feasibility in Endovascular Aneurysm Repair Using Currently Available Graft in Korea

• Bae T
• Lee T
• Jung IM
• Ha J
• Chung JK
• Kim SJ

• KMID: 1785824
• DOI: http://doi.org/10.3346/jkms.2008.23.4.651

Abstract

Despite the wide acceptance of endovascular aneurysmal repair in patients with abdominal aortic aneurysm (EVAR), stringent morphologic criteria recommended by manufacturers may preclude this treatment in patients with AAA. The purpose of this study was to investigate how many patients are feasible by Zenith and Excluder stent graft system, which are available in Korea. Eighty-two AAA patients (71 men, mean age 70 yr) who had been treated surgically or medically from January 2005 to December 2006 were included. Criteria for morphologic suitability (MS) were examined to focus on characteristics of aneurysm; proximal and distal landing zone; angulation and involvement of both iliac artery aneurysms. Twenty-eight patients (34.1%) were feasible in Zenith stent graft and 31 patients (37.8%) were feasible in Excluder. The patients who were excluded EVAR had an average of 1.61 exclusion criteria. The main reasons for exclusion were an unfavorable proximal neck (n=34, 41.5%) and problem of distal landing zone (n=25, 30.5%). There was no statistical significance among gender, age or aneurysm size in terms of MS. Only 32 patients (39%) who had AAA were estimated to be suitable for two currently approved grafts by strict criteria. However, even unfavorable AAA patients who have severe co-mobidities will be included in EVAR in the near future. Therefore, more efforts including fine skill and anatomical understanding will be needed to meet these challenging cases.

Keyword

Aortic Aneurysm, Abdominal; Suitability; EVAR

MeSH Terms

Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal/pathology/*surgery
*Blood Vessel Prosthesis Implantation/methods
Female
Humans
Male
Middle Aged

Figure

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  Fig. 1 Schematic review of Zenith inclusion criteria. *, inclusion criteria of Excluder, 2006.

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  Fig. 2 Cases that were excluded for EVAR (A) CIA aneurysm involving both EIA and IIA. No feasible distal fixation zone was shown. (B) Inadequate infrarenal angle (125.9°). (C) Proximal short neck. Arrow indicates the lowest renal artery. The distance from lower margin of renal artery to aneurysm neck is about 5 mm. (D) Bilateral CIA aneurysm. Both CIA diameter was measured over 20 mm at the iliac bifurcation level.

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