PURPOSE: To assess the impact of using inner wall vs. outer wall measurements on stent-graft sizing for endovascular repair of abdominal aortic aneurysm (AAA). METHODS: Preoperative static and electrocardiographically-gated 64-slice computed tomographic angiography (CTA) datasets were acquired on 40 consecutive AAA patients (29 men; mean age 78.9 ± 6 years, range 75-89). On static images, the aortic neck diameters were manually measured twice by 2 readers at 3 clinically relevant levels (supra-, juxta-, and infrarenal). The measurements were obtained from intima-to-intima (inner wall) and from adventitia-to-adventitia (outer wall). Dynamically reconstructed scans were also reviewed in each phase of the cardiac cycle to identify inner and outer minimum/maximum diameters. Using inner and outer wall measurements performed on static images, readers selected the size of a stent-graft that required inner neck diameter measurements and then one that required outer wall diameters. To calculate the relative oversizing, each selected stent-graft size was compared to that obtained using dynamic measurements. Oversizing <4% or >30% was considered inadequate. RESULTS: Mean variations for the inner and outer wall diameters of 9.75% ± 4.01% and 8.66% ± 3.71%, respectively, were recorded on static CTAs; the absolute changes in diameters were 1.82 ± 0.63 mm and 1.91 ± 0.64 mm, respectively. No statistically significant differences were found relative to aortic pulsatility at the 3 levels in the neck for the inner or outer wall diameters. Significant variability was seen between inner (mean 20.8 ± 3.4 mm) vs. outer (mean 23.7 ± 4.3 mm; p < 0.05) wall diameters. Stent-graft sizes significantly changed on the basis of the measurement method and device; for example, using the outer diameter to size a stent-graft that requires an inner diameter reference changed 36% of the selected stent-graft sizes, with ~20% being excessively oversized. Conversely, using the inner diameter to size an outer-diameter-based stent-graft resulted in nearly 40% of the sizes being altered. Based on dynamic measurements, the changes were more dramatic: the oversizing was considered excessive in up to 90% of patients if the measurement method did not match the stent-graft's stipulated reference. CONCLUSIONS: These data suggest that stent-graft sizing should follow the manufacturer's recommendations for using inner or outer diameter references based on dynamic patterns (mean value between diastolic and systolic diameters suggested).

Iezzi, R., Dattesi, R., Pirro, F., Nestola, M., Santoro, M., Snider, F., Bonomo, L., CT angiography in stent-graft sizing: impact of using inner vs. outer wall measurements of aortic neck diameters., <<JOURNAL OF ENDOVASCULAR THERAPY>>, 2011; (Giugno): 280-288 [http://hdl.handle.net/10807/6711]

CT angiography in stent-graft sizing: impact of using inner vs. outer wall measurements of aortic neck diameters.

Iezzi;Roberto; Dattesi;Roberta; Pirro;Federica; Nestola;Massimiliano; Santoro;Marco; Snider;Francesco; Bonomo
2011

Abstract

PURPOSE: To assess the impact of using inner wall vs. outer wall measurements on stent-graft sizing for endovascular repair of abdominal aortic aneurysm (AAA). METHODS: Preoperative static and electrocardiographically-gated 64-slice computed tomographic angiography (CTA) datasets were acquired on 40 consecutive AAA patients (29 men; mean age 78.9 ± 6 years, range 75-89). On static images, the aortic neck diameters were manually measured twice by 2 readers at 3 clinically relevant levels (supra-, juxta-, and infrarenal). The measurements were obtained from intima-to-intima (inner wall) and from adventitia-to-adventitia (outer wall). Dynamically reconstructed scans were also reviewed in each phase of the cardiac cycle to identify inner and outer minimum/maximum diameters. Using inner and outer wall measurements performed on static images, readers selected the size of a stent-graft that required inner neck diameter measurements and then one that required outer wall diameters. To calculate the relative oversizing, each selected stent-graft size was compared to that obtained using dynamic measurements. Oversizing <4% or >30% was considered inadequate. RESULTS: Mean variations for the inner and outer wall diameters of 9.75% ± 4.01% and 8.66% ± 3.71%, respectively, were recorded on static CTAs; the absolute changes in diameters were 1.82 ± 0.63 mm and 1.91 ± 0.64 mm, respectively. No statistically significant differences were found relative to aortic pulsatility at the 3 levels in the neck for the inner or outer wall diameters. Significant variability was seen between inner (mean 20.8 ± 3.4 mm) vs. outer (mean 23.7 ± 4.3 mm; p < 0.05) wall diameters. Stent-graft sizes significantly changed on the basis of the measurement method and device; for example, using the outer diameter to size a stent-graft that requires an inner diameter reference changed 36% of the selected stent-graft sizes, with ~20% being excessively oversized. Conversely, using the inner diameter to size an outer-diameter-based stent-graft resulted in nearly 40% of the sizes being altered. Based on dynamic measurements, the changes were more dramatic: the oversizing was considered excessive in up to 90% of patients if the measurement method did not match the stent-graft's stipulated reference. CONCLUSIONS: These data suggest that stent-graft sizing should follow the manufacturer's recommendations for using inner or outer diameter references based on dynamic patterns (mean value between diastolic and systolic diameters suggested).
Inglese
Iezzi, R., Dattesi, R., Pirro, F., Nestola, M., Santoro, M., Snider, F., Bonomo, L., CT angiography in stent-graft sizing: impact of using inner vs. outer wall measurements of aortic neck diameters., <<JOURNAL OF ENDOVASCULAR THERAPY>>, 2011; (Giugno): 280-288 [http://hdl.handle.net/10807/6711]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/6711
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