Advancing Endovascular Solutions for Complex Abdominal Aortic Aneurysms: Patient Selection, Imaging, and Device Innovations

Abstract

ABSTRACT

BACKGROUND

 Abdominal aortic aneurysm (AAA) poses a significant health risk, with a prevalence of 4.8% in individuals over 65 years old and becomes a surgical concern when the diameter exceeds 5.5 cm due to the heightened risk of rupture. Endovascular aneurysm repair (EVAR) has emerged as the primary approach, particularly for infrarenal AAAs, offering advantages over traditional open surgery. However, complex anatomies challenge standard EVAR, prompting the development of innovative endografts. This study reviews the literature on the treatment of complex abdominal aortic aneurysms (C-AAAs), focusing on patient selection, preoperative imaging, and available devices.

METHODS

A comprehensive literature review was conducted on C-AAAs, encompassing treatment options, patient selection criteria, and preoperative imaging. Searches in PubMed and Google Scholar utilized keywords such as “complex abdominal aortic aneurysm,” “fenestrated endovascular aortic repair (FEVAR),” “branched endovascular aortic repair (BEVAR),” “chimney endovascular aortic repair (chEVAR),” and “patient selection.” Additional relevant articles were identified through cross-referencing.

RESULTS

Patient selection for C-AAA endovascular treatment involves assessing rupture risk, operative mortality, life expectancy, and anatomical considerations. The impact of age on outcomes remains inconclusive across different studies. Preserving renal function is crucial, particularly in patients with renal anomalies, which require careful evaluation. Precise measurements guide clinical decisions, considering factors such as aortic tortuosity. Preoperative imaging—particularly computed tomography angiography (CTA)—is essential, as it provides comprehensive anatomical information. Intraoperative fusion imaging enhances real-time assessment and contributes to procedural precision. Device selection, including FEVAR, BEVAR, and chEVAR, must be tailored to individual anatomy, with custom-made, off-the-shelf, and physician-modified devices offering a range of options.

CONCLUSION

The endovascular treatment of C-AAAs has undergone significant advancements, transforming therapeutic strategies. Optimal outcomes depend on meticulous patient selection, comprehensive preoperative imaging, and tailored device choice. Ongoing research should refine risk assessment, optimize device modifications, and expand the applicability of endovascular interventions for complex aortic anatomies.