title: Semiautomatic sizing software in emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysms.
abstract: OBJECTIVE
  In emergency endovascular repair (EVAR) of ruptured aneurysms of the aorta (rAAA), anatomical suitability must be determined. Semiautomatic three-dimensional assessment of the aortoiliac arteries has the potential to standardise measurements. This study assesses the fitness for purpose of such a semiautomatic approach for rAAA and determined interobserver agreement on suitability.
  
  
  METHODS
  Interobserver study with six trained observers (4 vascular surgeons, 2 radiologists) blindly assessing preoperative computed tomography angiography scans of 50 consecutive patients with rAAA. A central lumen line (CLL) was generated, and perpendicular diameters, length along the CLL, and EVAR suitability were determined using dedicated sizing software (3mensio; 3mensio Vascular; Bilthoven, The Netherlands). Success of generating a CLL, time of assessment, and interobserver agreement was determined.
  
  
  RESULTS
  In the majority of the patients (median 76 %, range 64-78 %), a CLL was semiautomatically generated. The median duration of CLL generation and performance measurements was 7.5 min (interquartile range 5.5-10.6). Agreement on suitability was moderate for the entire group (Fleiss' κ = 0.55, confidence interval 0.48-0.62) and ranged from moderate to good (Cohen's κ = 0.40-0.72) between observer pairs.
  
  
  CONCLUSIONS
  Assessing EVAR suitability of rAAA patients using dedicated sizing software is possible in the majority of patients. The measurements can be performed in a reasonable amount of time, and the agreement of suitability for EVAR in patients with rAAA is moderate. Improvements and additional research are necessary to replace the current axial measurement.
authors.affiliation: Vascular Surgery Section, Department of Vascular Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, j.j.reimerink@amc.nl.
authors.forename: Jorik J
authors.initials: JJ
authors.lastname: Reimerink
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
authors.forename: Anco
authors.initials: A
authors.lastname: Vahl
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
authors.forename: Michiel A
authors.initials: MA
authors.lastname: Schreve
authors.forename: Diederick W
authors.initials: DW
authors.lastname: De Boo
authors.forename: Jim A
authors.initials: JA
authors.lastname: Reekers
authors.forename: Dink A
authors.initials: DA
authors.lastname: Legemate
authors.forename: Ron
authors.initials: R
authors.lastname: Balm
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D003287:Contrast Media; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D009426:Netherlands; D011474:Prosthesis Design; D012984:Software; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media