Iliac artery deformation during EVAR

Koutouzi G, Pfister M, Breininger K, Hellström M, Roos H, Falkenberg M (2019)

Publication Type: Journal article

Publication year: 2019


DOI: 10.1177/1708538119840565


Objectives: To quantify the deformation of the common iliac artery caused by stiff guide wires and delivery systems during abdominal endovascular aortic repair (EVAR). Methods: Twenty-two patients treated with abdominal EVAR were included. The following three image data-sets were acquired for each patient: (1) a preoperative computed tomography angiography (CTA), (2) an intraoperative contrast-enhanced cone beam CT (CBCT) obtained after the main trunk of the bifurcated stent graft was released and both iliac limbs were engaged with stiff guide wires, and (3) the first postoperative CTA. These data-sets were merged and compared in an image analysis work station. The length and the tortuosity index of the common iliac artery, the Euclidian displacement of the aortic and the iliac bifurcations, and the optimal C-arm angulation for projection of the iliac bifurcation were computed. Results: The common iliac artery was on average 6.4 mm shorter (p < 0.001) and tortuosity index was lower (p = 0.003) in the intraoperative images compared to preoperative. Some of the foreshortening was reversed postoperatively, remaining mean length difference was 2.9 mm (p = 0.007) compared to preoperative. Intraoperatively, the aortic bifurcation was mostly displaced in a cranial direction (100%) and the iliac bifurcation in a ventral direction (93%). The optimal lateral C-arm angulation for projection of the iliac bifurcation changed. Anterior contralateral angle increased from median 42° (IQR, 27–63) in the preoperative CTA to 62 (49–74) in the intraoperative CBCT (p = 0.02). Optimal cranio-caudal angulation did not change. Conclusion: Stiff guide wires and delivery systems cause significant deformation of the common iliac arteries during EVAR. The aortic bifurcation is more cranial, the common iliac arteries are shorter, and optimal C-arm angulation is more contralateral oblique when the iliac limbs are to be deployed compared to baseline measurements from preoperative CTA. This affects image fusion accuracy and stent graft selection.

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Koutouzi, G., Pfister, M., Breininger, K., Hellström, M., Roos, H., & Falkenberg, M. (2019). Iliac artery deformation during EVAR. Vascular.


Koutouzi, Giasemi, et al. "Iliac artery deformation during EVAR." Vascular (2019).

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