title: Endovascular repair of abdominal aortic aneurysm without preoperative arteriography.
abstract: OBJECTIVE
  Clinical trials of endovascular aortic aneurysm repair (EVAR) have required both preoperative aortography and computed tomography (CT). We codeveloped specialized three-dimensional (3-D) reconstruction and computer-aided measurement, planning, and simulation software (3-D CAMPS) based on CT or magnetic resonance imaging, to eliminate the need for preoperative arteriography.
  
  
  METHODS
  EVAR with 3-D CAMPS as the sole preoperative imaging method was performed in 196 patients from 1996 to 2001, with six endograft types in three configurations. Physical examination, abdominal radiography, and CT (3D-CAMPS) were performed at 1, 6, and 12 months, then annually.
  
  
  RESULTS
  For a subset of cases in which a comparison could be made, 3-D CAMPS was superior to angiography for prediction of endograft length and iliac access. Hospital mortality was zero, and 30-day mortality was 0.5%. In three patients immediate conversion to open repair (1.5%) was necessary because of previously unknown stent-graft mechanical limits. Incidence of endoleak was 15% at 1 month, 10% at 6 months, 6% at 12 months, and 7% at 24 months, and 92% of endoleaks were type II. Mean follow-up was 18 months. Aneurysm-related mortality was zero. Nineteen secondary procedures (all endovascular) were performed in 16 patients (8%). For all graft types, freedom from secondary procedure was 94% at 1 year and 90% at 2 years, and this was better for endografts ultimately approved by the US Food and Drug Administration (96% at 1 year, 95% at 2 years; P =.02). No known measurement-related complications occurred in the series. Results for secondary intervention and endoleak compare favorably to series with similar endograft types.
  
  
  CONCLUSIONS
  EVAR can be performed with 3-D CAMPS as the sole preoperative imaging method to achieve outcomes comparable to the best series published for each endograft type. CT with 3-D CAMPS can effectively eliminate the need for preoperative arteriography and avert associated morbidity, expense, and exposure to contrast agent and radiation.
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Wyers
authors.forename: Mark F
authors.initials: MF
authors.lastname: Fillinger
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powell
authors.forename: Eva M
authors.initials: EM
authors.lastname: Rzucidlo
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
authors.forename: Robert M
authors.initials: RM
authors.lastname: Zwolak
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D011300:Preoperative Care; D012984:Software; D015607:Stents; D036542:Tomography, Spiral Computed