Juxtarenal aortic aneurysm - Endovascular treatment and imaging techniques

Abstract: Treatment of abdominal aortic aneurysms has shifted rapidly from open surgery to minimally invasive endovascular aneurysm repair (EVAR). However, anatomical limitations such as short or absent proximal sealing neck and poor access vessels exclude up to 50% of patients. In attempt to increase the number of patients suitable for EVAR, fenestrated devices have emerged. In this new era, precise and reproducible imaging is of paramount importance for device planning and assessing operative risk and success. Thin-slice CT scans, digital imaging and software to analyze and reconstruct vessels in 3D have rendered previous imaging methods out-of-date. The aim of this thesis was to evaluate: 1. The results of endovascular treatment of juxtarenal aortic aneurysms with fenestrated devices (FEVAR). 2. Different methods and measuring modalities used in preoperative aneurysm diameter measurements. 3. Subjective and objective methods used for iliac tortuosity assessment and to establish a simple reproducible method for iliac tortuosity evaluation prior to endovascular repair. 4. The correlation of the anatomic severity grading score to operative success and outcomes after FEVAR. Our results show that FEVAR is a procedure with good short- and midterm results that offers a valid treatment alternative to patients unsuitable for standard EVAR. Ultrasound readings are consistently smaller then when measured by any means on CT reconstructions, which should be taken into account when recommending intervention for smaller aneurysms. Subjective assessment of iliac tortuosity has poor agreement with iliac tortuosity index, which is reproducible with good agreement between observers. Our new more simple method for iliac tortuosity evaluation can replace tortuosity index. The anatomic severity grading score is of value in predicting procedure time, adverse events, adjunctive maneuvers, radiation exposure and postoperative complications after FEVAR.