Computed tomographic angiographic imaging of abdominal aortic aneurysms: Implications for transfemoral endovascular aneurysm management

Purpose: To describe anatomic features pertinent to patient selection and graft design for transfemoral endovascular aneurysm management (TEAM) of the infrarenal aorta using computed tomographic (CT) angiography. Methods: A prospective noncomparative analysis of 102 spiral CT scans of the abdominal aorta of patients with abdominal aortic aneurysms was performed. From the original CT data set, slices were reconstructed perpendicular to the vessel axis (central lumen line) at a 10 mm interval. In these reconstructed slices, diameter measurements were performed. Vessel length was measured along the central lumen line. In each patient possibilities for TEAM were analyzed. Results: Because of technical reasons, 36 scans were excluded from the analysis. Of the remaining 66 patients, 18 could potentially be treated with a bifurcated endovascular device. The infrarenal aortic diameter-to-iliac artery diameter ratio was less than 2 in most patients. The vessel segments judged to be adequate for endovascular graft anchoring had a noncylindrical shape in the majority of cases. Conclusion: Only a minority of patients with abdominal aortic aneurysms can at this stage be treated with an endovascular graft, The ideal endovascular graft should be a combination of rigid and flexible components, The proximal and distal attachment systems should have some flexibility with an intrinsic maximum diameter while the midsection of the graft can be relatively rigid.