Patient Selection Criteria for Endovascular Aortic Aneurysm Repair: Optimizing Outcomes

Abstract

Endovascular aortic aneurysm repair (EVAR) has become the preferred treatment for abdominal aortic aneurysms, offering a minimally invasive alternative to open surgery. However, successful outcomes depend on meticulous patient selection. This review explores the key criteria for patient eligibility, including aneurysm size, morphology, and the quality of the proximal and distal aneurysm necks. Additionally, imaging assessment and various device variables, including anatomical suitability, are examined to emphasize their influence on procedural success. As EVAR technology evolves, understanding the nuances of patient selection remains crucial for maximizing technical success and clinical outcomes, while minimizing complications including endoleaks and migration, and extending the benefits of the procedure to a broader range of patients.

Keywords

endovascular aortic aneurysm repair - aortic aneurysm - endoleaks - abdominal aortic aneurysm

Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2025

• References

• 1 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5 (06) 491-499
• 2 Volodos NL, Shekhanin VE, Karpovich IP. Self-fixing graft for distant endografting of aorta and other arteries. Modern approaches for prophylaxis and treatment of arteries diseases. All Soviet Union Conference, Moscow, March 20–22, 1985
• 3 Patel PB, Marcaccio CL, Swerdlow NJ. et al. Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative. J Vasc Surg 2023; 78 (02) 269-277.e3
• 4 Oliveira NFG, Bastos Gonçalves FM, Van Rijn MJ. et al. Standard endovascular aneurysm repair in patients with wide infrarenal aneurysm necks is associated with increased risk of adverse events. J Vasc Surg 2017; 65 (06) 1608-1616
• 5 Jouhannet C, Alsac JM, Julia P. et al. Reinterventions for type 2 endoleaks with enlargement of the aneurismal sac after endovascular treatment of abdominal aortic aneurysms. Ann Vasc Surg 2014; 28 (01) 192-200
• 6 Dias AP, Farivar BS, Steenberge SP. et al. Management of failed endovascular aortic aneurysm repair with explantation or fenestrated-branched endovascular aortic aneurysm repair. J Vasc Surg 2018; 68 (06) 1676-1687.e3
• 7 Martin Z, Greenberg RK, Mastracci TM, Eagleton MJ, O'Callaghan A, Bena J. Late rescue of proximal endograft failure using fenestrated and branched devices. J Vasc Surg 2014; 59 (06) 1479-1487
• 8 Scali ST, Feezor RJ, Chang CK. et al. Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern. J Vasc Surg 2014; 60 (04) 865-873 , discussion 873–875
• 9 De Martino RR, Goodney PP, Nolan BW. et al; Vascular Study Group of New England. Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy. J Vasc Surg 2013; 58 (03) 589-595
• 10 Krishnamurthy VN, Rectenwald JE. Patient selection criteria for endovascular aortic aneurysm repair. In: Upchurch GR, Criado E. eds. Aortic Aneurysms. Contemporary Cardiology. Humana Press; 2009. Accessed November 25, 2024 at: https://doi.org/10.1007/978-1-60327-204-9_6
• 11 Chaikof EL, Dalman RL, Eskandari MK. et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67 (01) 2-77.e2
• 12 Wanhainen A, Van Herzeele I, Bastos Goncalves F. et al; ESVS Guidelines Committee, Document Reviewers. Editor's choice – European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg 2024; 67 (02) 192-331
• 13 Gargiulo M, Gallitto E, Wattez H. et al. Outcomes of endovascular aneurysm repair performed in abdominal aortic aneurysms with large infrarenal necks. J Vasc Surg 2017; 66 (04) 1065-1072
• 14 McFarland G, Tran K, Virgin-Downey W. et al. Infrarenal endovascular aneurysm repair with large device (34- to 36-mm) diameters is associated with higher risk of proximal fixation failure. J Vasc Surg 2019; 69 (02) 385-393
• 15 Barry IP, Turley LP, Mwipatayi DL, Thomas A, Mwipatayi MT, Mwipatayi BP. The impact of endograft selection on outcomes following treatment outside of instructions for use (IFU) in endovascular abdominal aortic aneurysm repair (EVAR). Cureus 2021; 13 (05) e14841
• 16 Tsilimparis N, Gouveia E Melo R, Tenorio ER. et al. Multicenter study on physician-modified endografts for thoracoabdominal and complex abdominal aortic aneurysm repair. Circulation 2024; 150 (17) 1327-1342
• 17 Chait J, Tenorio ER, Hofer JM, DeMartino RR, Oderich GS, Mendes BC. Five-year outcomes of physician-modified endografts for repair of complex abdominal and thoracoabdominal aortic aneurysms. J Vasc Surg 2023; 77 (02) 374-385.e4
• 18 Spath P, Tsilimparis N, Furlan F, Hamwi T, Prendes CF, Stana J. Additional aortic coverage with an off the shelf, multibranched endograft compared with custom made devices for endovascular repair of pararenal abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2023; 65 (05) 710-718
• 19 Gouveia E Melo R, Fernández Prendes C, Caldeira D. et al. Systematic review and meta-analysis of physician modified endografts for treatment of thoraco-abdominal and complex abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2022; 64 (2-3): 188-199
• 20 Oliveira-Pinto J, Oliveira NFG, Bastos-Gonçalves FM. et al. Long-term results after standard endovascular aneurysm repair with the Endurant and Excluder stent grafts. J Vasc Surg 2020; 71 (01) 64-74
• 21 Vallabhaneni SR, Patel SR, Campbell B. et al. Editor's choice - comparison of open surgery and endovascular techniques for juxtarenal and complex neck aortic aneurysms: The UK COMPlex AneurySm Study (UK-COMPASS) - peri-operative and Midterm Outcomes. Eur J Vasc Endovasc Surg 2024; 67 (04) 540-553