Suitability of ruptured AAA for endovascular repair

Purpose: To determine the anatomical suitability and the range of endografts required to undertake an endovascular repair (EVR) program for ruptured abdominal aortic aneurysms. Methods: The morphology of ruptured and nonruptured AAAs were compared by retrospective review of computed tomographic scans from 51 patients (47 men; mean age 76 years, range 55-90) with ruptured AAAs and 50 patients (37 men; mean age 74 years, range 57-75) with nonruptured AAAs. Three experienced clinicians reviewed the Scans for EVR suitability based on a generic trimodular endograft with suprarenal fixation. Endograft oversizing was assumed to be 10% to 20%. Results: Interobserver agreement was high, with a mean kappa of 0.78 (range 0.75-0.83, P<0.001). In all, 41% of ruptured and 68% of nonruptured AAAs were suitable for EVR (p=0.009). Ruptured AAAs had shorter mean neck lengths (17+/-12 versus 22+/-11 mm, p=0.031) and larger mean aneurysm diameters (75+/-15 versus 63+/-9 mm, p>0.001). Neck length and neck diameter were significantly correlated for ruptured AAAs (r=-0.34, p=0.018). The main contraindication to EVR was hostile neck morphology. A range of endografts with aortic components from 24 to 32 mm and iliac components from 12 to 22 mm would be required to stent 41% of ruptured AAAs. Conclusions: Ruptured AAAs are less suitable for EVR due to differing neck morphology. An EVR program for ruptured AAA requires an inventory of endografts with appropriate aortic and iliac components.