title: Changes in Aortoiliac Anatomy After Elective Treatment of Infrarenal Abdominal Aortic Aneurysms with a Sac Anchoring Endoprosthesis.
abstract: OBJECTIVE
  Endovascular aortic sealing (EVAS) with the Nellix endosystem (Endologix, Irvine, CA, USA) is a new concept to treat infrarenal abdominal aortic aneurysms (AAAs). By sealing the aneurysm, potential endoleaks may be avoided. Early results of EVAS are good, but no data have been published regarding peri-procedural changes in aortoiliac anatomy. In this study, 27 consecutive patients who underwent elective EVAS repair of an AAA were reviewed.
  
  
  METHODS
  Specific AAA (diameter, length from renal arteries to aortic bifurcation, supra- and infrarenal neck angulation, AAA volume, thrombus volume, and flow lumen volume), and iliac artery characteristics (length, angulation, location of most severe angulation with reference to the origin of the common iliac artery) were determined from pre- and post-procedural reconstructed computed tomography angiograms.
  
  
  RESULTS
  No type I or II endoleaks were seen at 30 day follow up. Total AAA volume, suprarenal and infrarenal angulation, as well as aortic neck diameter did not change significantly post-EVAS. AAA flow lumen increased significantly (mean difference -4.4 mL, 95% CI 2.0 to -8.6 mL) and AAA thrombus volume decreased (mean difference 3.2 mL, 95% CI 2.0 to -1.1 mL). AAA length (125.7 mm vs. 123.1 mm), left common iliac artery length (57.6 mm vs. 55.3 mm), and right and left maximum iliac artery angulation (right 37.4° vs. 32.2°; left: 43.9° vs. 38.4°) were reduced significantly and the location of maximum angulation was further from the iliac artery origin post-EVAS, suggesting slight straightening of the aortoiliac anatomy.
  
  
  CONCLUSIONS
  Most aortoiliac anatomic characteristics remained unchanged post-EVAS. Filling of the endobags to a pressure of 180 mmHg may lead to lost thrombus volume in some patients, probably because liquid is squeezed into lumbar or the inferior mesenteric artery. The absolute differences in pre- and post-EVAS aortoiliac lengths were small, so pre-operative sizing is accurate for determining stent length.
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Technical Medicine, Technical University, Enschede, The Netherlands.
authors.forename: J T
authors.initials: JT
authors.lastname: Boersen
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Technical Medicine, Technical University, Enschede, The Netherlands.
authors.forename: R C L
authors.initials: RC
authors.lastname: Schuurmann
authors.affiliation: Department of Technical Medicine, Technical University, Enschede, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: Slump
authors.affiliation: Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: D A F
authors.initials: DA
authors.lastname: van den Heuvel
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: M M P J
authors.initials: MM
authors.lastname: Reijnen
authors.affiliation: Department of Technical Medicine, Technical University, Enschede, The Netherlands; Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: T G
authors.initials: TG
authors.lastname: ter Mors
authors.affiliation: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Vahl
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: j.vries@antoniusziekenhuis.nl.
authors.forename: J P P M
authors.initials: JP
authors.lastname: de Vries
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aortoiliac anatomy; Endovascular aneurysm sealing; Infrarenal abdominal aortic aneurysm