Morphological applicability of currently available stent grafts in the endovascular repair of asymptomatic abdominal aortic aneurysm in East-Central European patients

Introduction
Currently, there is a wide range of commercially available devices for endovascular aneurysm repair (EVAR) that differ in terms of both anatomical requirements and the technology and technique of deployment. Aim: To assess the applicability of currently commercially available devices for EVAR in the treatment of an asymptomatic abdominal aneurysm (AAA).

Material and methods
The study group included 100 patients with infrarenal AAA with a maximum diameter ≥ 50 mm, qualified for invasive treatment at the University Hospital in 2013–2014. The aortoiliac morphological characteristics of the AAA were evaluated on preoperative computed tomography angiograms using the OsiriX DICOM viewer in the 3D-MPR mode. The morphological applicability of 14 types of CE-marked and FDA-approved stent grafts was determined based on their instructions for use (IFU).

Results
EVAR was feasible with at least one of the analysed devices in 68% of patients. The morphological applicability was as follows: Excluder Conformable (65%), Ovation iX (51%), Endurant II (47%), Treo (45%), Excluder C3 (45%), AFX 2 (45%), Incraft (44%), E-tegra (44%), Zenith Alfa (41%), Zenith Flex (40%), Anaconda (39%) Aorfix (37%), Altura (34%), and E-vita (20%). The differences in the stent graft applicability were statistically significant (p < 0.001). A wide diameter of the common iliac artery, angulated proximal neck, and diameter of proximal neck out of range constituted the most frequent causes of EVAR inapplicability.

Conclusions
The IFU-based applicability of currently available AAA stent graft systems differs significantly. Despite the constant evolution of EVAR technology, at least 32% of AAA will require a different therapeutic approach.