Endovascular aneurysm repair with a bifurcated endovascular graft at a primary referral center: influence of experience, age, gender, and aneurysm size on suitability.
OBJECTIVE
The purpose of this study was to assess the suitability for endovascular repair of abdominal aortic aneurysm (EVAR) in an unselected patient population.


METHODS
Between February 1999 and May 2002 all consecutive patients with a nonemergent abdominal aortic aneurysm (AAA) were prospectively examined with contrast material-enhanced spiral computed tomography (CT). Those patients probably suitable for EVAR on the basis of CT findings underwent calibrated angiography. A panel of radiologists and vascular surgeons reviewed the clinical data and vascular anatomy, and decided on the appropriateness of EVAR with the bifurcated Zenith AAA endovascular graft.


RESULTS
One hundred seven patients were included. Fifty-six patients (52%) had one or more contraindications for EVAR. Unsuitability was most frequently (88%) related to the proximal neck. Inadequate neck length was the most common specific reason. Inadequate iliac anatomy was the reason for unsuitability in 59% of patients. The rate of unsuitability decreased from 61% during the first half of the study to 40% during the second half (P =.03) Unsuitability was equal between men and women. Age and maximum diameter did not differ between candidates and noncandidates.


CONCLUSIONS
Almost half (48%) of patients with an infrarenal AAA referred to a primary referral center are suitable for EVAR with the bifurcated Zenith AAA endovascular graft. Neck anatomy was the most frequent reason for rejection. Rate of suitability increased over time, probably as a result of increasing experience. Suitability was not influenced by gender, age, or aneurysm size.
Simons
Petra
P
Department of Radiology and Vascular Surgery, Leyenburg Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands. fwahasel@tref.nl
van Overhagen
Hans
H
Nawijn
Auke
A
Bruijninckx
Boy
B
Knippenberg
Bob
B
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed