สัณฐานวิทยาของภาวะหลอดเลือดแดงใหญ่ส่วนช่องท้องโป่งพองที่มีผลต่อการรักษาผ่านสายสวนหลอดเลือด

Abstract

Objective: To evaluate the morphology of infrarenal AAA, the proportion of the patients with AAA would be eligible for EVAR and to identify the morphologic features unfit for minimal requirements for standard commercially available endografts. Methods and Materials: We retrospective review CT images of 94 patients with AAA from our radiology database from September 2013 to November 2014. Images were reconstructed for morphologic features evaluation and measurements. Eligibility criteria determined by manufacturer and published guideline were applied for patients who fit with those requirements. Results: The mean age was 73.03±8.0 years and 57.45% of patients were men. Most of the patients had grade 3 aneurysmal sac thrombus. The most common type of the proximal neck was parallel. The average size of the aneurysm sac was 56.8±15.4 mm. Iliac artery diameter in men was larger than women. Among the Asians, Thais had smaller external iliac artery with mean diameter of 6.8 to 6.9 mm. Severe aortic tortuosity was found in 22.3%. Severe right and left iliac tortuosity were found in 27.7% and 28.3%. Eligibility for EVAR by European Society for Vascular Surgery, Zenith Flex®, Excluder® and Endurant II® were 5.3%, 33.0%, 26.6% and 39.4% respectively Conclusion: As compared to the Westerns and other Asians, Thais have smaller EIA diameter. This is a major reason for ineligibility for EVAR in Thais, contrast to the proximal neck problems in the others. Our study supports development of devices with smaller profile, then devices with more coverage range for proximal neck diameter and angulation that would be benefit for AAA patients.

Keywords: Abdominal aortic aneurysm, Infrarenal, Endovascular, EVAR, Morphology