Anatomical suitability of ruptured abdominal aortic aneurysms for endovascular repair.

PURPOSE

To assess the anatomical suitability of ruptured abdominal aortic aneurysms (AAA) for emergency endovascular repair.

METHODS

All cases (46 patients [35 men; mean age 74 years, range 54-85]) in which computed tomographic angiography (CTA) confirmed AAA rupture over a 5-year period at our university hospital were reviewed for anatomical suitability for endovascular repair. Measurements were made by a radiologist experienced in anatomical assessment of CT criteria for elective endovascular aneurysm repair (EVAR).

RESULTS

The mean aneurysm neck length was 18 mm (range 0-59); 17 were conical, 13 straight, 4 barrel, and 6 reverse conical. Six cases had no proximal neck. Overall, 37 (80%) patients were unsuitable for EVAR according to our criteria. Nearly half the patients (22, 48%) had > or =2 adverse features. Unsuitable neck morphology (35, 76%) was the primary reason for exclusion, but CIA aneurysm (10, 22%) and EIA tortuosity (7, 15%) were secondary adverse features.

CONCLUSIONS

With current stent-graft design, the majority of ruptured abdominal aortic aneurysms are anatomically unsuitable for endovascular repair.