title: Iliac and femoro-popliteal arteries morphological CTA features as determinants of outcome after standard EVAR procedures.
abstract: BACKGROUND
  To evaluate the impact of iliac artery's diameters, tortuosity, and peripheral vascular patency on outcome of elective endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) in 2 high volume vascular centers' experience.
  
  
  METHODS
  A retrospective study was conducted on a prospectively collected database between 2010 and 2012. Anatomical features at pre-operative computed tomography (CTA) considered as potentially influencing outcomes were: iliac diameters, tortuosity (expressed as a ratio), and calcifications, bilateral internal iliac artery (IIA) patency, and presence of Trans-Atlantic Inter-Societies Consensus (TASC) II C/D femoro-popliteal occlusive disease (PAD). Outcome measures were reintervention and mortality rates at follow-up.
  
  
  RESULTS
  Two-hundred-eighty-nine patients' CTA preoperative images were reviewed with a mean of 1148±328 images per patient analyzed. Mean common iliac artery (CIA) diameters calculated in the narrowest point were 12.8±4 mm and 12.9±3.9 mm, and mean external iliac artery (EIA) diameters were 7.7±1.6 mm 7.8±1.7 mm, respectively on right and left side. Mean tortuosity ratios were 0.8±0.1 (0.40-0.91) and 0.8±0.1 (0.49-0.99), respectively on right and left side. PAD was present in 31 patients (10.7%). Technical success was achieved in all case, and bilateral IIA patency was preserved in 229 (79.2%) patients. No in hospital and 30-day mortality and complications were recorded. At a mean follow-up of 26 months, 30 reinterventions were required in 26 patients (8.9%), and 22 (7.6%) non AAA-related deaths were noted. Right EIA diameter ≤5 mm (P=0.0012, OR 5.2, 95% CI 1.73-15.57), and femoro-popliteal steno-obstructive disease (P=0.03, OR 3.06, 95% CI 1.02-9.20) were significantly related to reinterventions during follow-up. Iliac tortuosity ratio and calcification were not significant predictors of adverse events.
  
  
  CONCLUSIONS
  This preliminary experience suggests that diameters of access vessels and the presence of femoro-popliteal steno-obstructive disease could affect the outcome of EVAR.
authors.affiliation: Unit of Vascular and Endovascular Surgery, &quot;Sapienza&quot; University of Rome, Rome, Italy - pasqualino.sirignano@uniroma1.it.
authors.forename: Pasqualino
authors.initials: P
authors.lastname: Sirignano
authors.affiliation: Unit of Vascular and Endovascular Surgery, &quot;Sapienza&quot; University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Speziale
authors.affiliation: Unit of Vascular and Endovascular Surgery, &quot;Sapienza&quot; University of Rome, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Capoccia
authors.affiliation: Unit of Vascular and Endovascular Surgery, &quot;Sapienza&quot; University of Rome, Rome, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Menna
authors.affiliation: Unit of Vascular and Endovascular Surgery, &quot;Sapienza&quot; University of Rome, Rome, Italy.
authors.forename: Wassim
authors.initials: W
authors.lastname: Mansour
authors.affiliation: Unit of Vascular and Endovascular Surgery, &quot;Sapienza&quot; University of Rome, Rome, Italy.
authors.forename: Nunzio
authors.initials: N
authors.lastname: Montelione
authors.affiliation: Unit of Vascular and Endovascular Surgery, University of Siena, Siena, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.affiliation: Unit of Vascular and Endovascular Surgery, University of Siena, Siena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galzerano
authors.affiliation: Unit of Vascular and Endovascular Surgery, University of Siena, Siena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D000072226:Computed Tomography Angiography; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D061847:Hospitals, High-Volume; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007558:Italy; D008297:Male; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D011150:Popliteal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D000074286:Preliminary Data; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency