Use of dynamic computed tomography to evaluate pre- and postoperative aortic changes in AAA patients undergoing endovascular aneurysm repair.
OBJECTIVE
To utilize dynamic computed tomographic angiography (CTA) on pre- and postoperative endovascular aneurysm repair (EVAR) patients to characterize cardiac-induced aortic motion within the aneurysm neck, an essential EVAR sealing zone.


METHODS
Electrocardiographically-gated CTA datasets were acquired utilizing a 64-slice Philips Brilliance CT scanner on 15 consecutive pre- and postoperative AAA patients. Axial pulsatility measurements were taken at 2 clinically relevant levels within the aneurysm neck: 2 cm above the highest renal artery and 1 cm below the lowest renal artery. Changes in aortic area and diameter were determined.


RESULTS
Significant aortic pulsatility exists within the aneurysm neck during the cardiac cycle. Preoperative aortic area increased significantly, with a maximum increase of up to 12.5%. The presence of an endograft did not affect aortic pulsatility (p=NS). Postoperative area also changed significantly during a heart cycle, with a maximum increase of up to 14.5%. Diameter measurements demonstrated an identical pattern, with significant pre- and postoperative intracardiac pulsatility within and above the aneurysm neck (p<0.05). An increase in maximum diameter change up to 15% was evident.


CONCLUSIONS
Patients undergoing EVAR experience aortic diameter changes within and above the aneurysm neck. The presence of an endograft does not abrogate this response to intracardiac pressure changes. Static CT imaging may not adequately identify patients with large aortic pulsatility, potentially resulting in endograft undersizing, stent-graft migration, intermittent type I endoleaks, and poor patient outcomes. The current standard regime of 10% to 15% oversizing based on static CT may be inadequate for some patients.
Teutelink
Arno
A
Departments of Vascular Surgery, University Medical Center, Utrecht, The Netherlands.
Muhs
Bart E
BE
Vincken
Koen L
KL
Bartels
Lambertus W
LW
Cornelissen
Sandra A
SA
van Herwaarden
Joost A
JA
Prokop
Mathias
M
Moll
Frans L
FL
Verhagen
Hence J M
HJ
D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D002932:Cineangiography / Q000379:methods*; D004548:Elasticity; D004562:Electrocardiography; D006801:Humans; D008297:Male; D015588:Observer Variation; D018579:Patient Selection; D011184:Postoperative Period; D011300:Preoperative Care; D011474:Prosthesis Design; D011673:Pulsatile Flow; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome