Endovascular treatment of infrarenal abdominal aortic aneurysm (AAA) offers a less invasive alternative to conventional open repair. Currently, only four devices are Food and Drug Administration (FDA)-approved for use in endovascular aneurysm repair (EVAR) of AAA in the United States. All four devices are associated with a high technical success rate and less morbidity than open surgical repair. Each device has its inherent design advantages and disadvantages that must be matched with patient and AAA characteristics. This review will discuss and compare the technology and procedural outcomes data of the current FDA-approved EVAR devices.
[Show abstract][Hide abstract] ABSTRACT: Endovascular stent grafts have become a viable treatment for aortic thoracic and abdominal aneurysms in both elective and emergent situations. Computed tomographic (CT) angiography is the primary tool for determining eligibility for this procedure. This article discuses the preprocedural evaluation of an endovascular stent candidate. Evaluation begins with identification of the aneurysm pathology and its relationship to treatment efficacy. The radiologist must evaluate the aneurysm geometry for compatibility with stent hardware. Aneurysm features that suggest a contraindication must be recognized. Procedures that involve a combination of endovascular stenting and surgical revascularization are discussed so that the reader understands the limits of stent eligibility. Vascular access for stent placement must also be evaluated for the ability to accommodate stent delivery. The radiologist also must be familiar with CT imaging protocols and alternative methods of imaging that can evaluate stent feasibility. The utility of three-dimensional processing is discussed.
Seminars in Interventional Radiology 03/2009; 26(1):44-55. DOI:10.1055/s-0029-1208383
[Show abstract][Hide abstract] ABSTRACT: Multidetector computed tomography angiography (MDCTA) allows high spatial resolution, including nearly isotropic submillimeter resolution in the X, Y, and Z planes, and rapid image acquisition in a single breath hold, with greatly enhanced diagnostic capabilities over conventional CT. MDCTA has largely replaced digital subtraction angiography because it is faster, less invasive, and provides more information. When technical parameters are optimized, it provides the radiologist with the information needed to diagnose life threatening diseases of the aortoiliac system, gives critical information for the vascular surgeon or interventional radiologist to treat that disease, and identifies subsequent complications related to therapy. This article briefly discusses the technical components and optimization of MDCTA of the abdominal aorta and iliac arteries (aortoiliac system) and examines the diseases of the aortoiliac system evaluated by MDCTA.
Radiologic Clinics of North America 03/2010; 48(2):283-309, viii. DOI:10.1016/j.rcl.2010.02.009 · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Endovascular repair of the abdominal aortic aneurysm has been established as a successful alternative to open surgical repair, provided that the criteria necessary for such an approach are fulfilled. Anatomic criteria include suitable diameter, length, and angle of the aneurysm proximal neck. We present three cases in which patients were initially ineligible for endovascular repair because of unfavorable neck anatomy but in whom the use of aortic cuffs allowed for successful endograft placement and aneurysm exclusion.
Journal of Radiology Case Reports 03/2010; 4(3):1-10. DOI:10.3941/jrcr.v4i3.344
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