Principles of EVAR planning and sizing – Chapter 2: Sizing & Oversizing
This is the second chapter of the EVAR tutorial about planning and sizing of the endovascular AAA repair. Following topics are included:
– How to measure exactly the right diameter of our proximal landing zone?
– How to oversize in angulated necks?
– Which ancillary products should be available in challenging cases?
– How to select the length and diameter of the iliac limbs?
– Specific scenarios
Good teaching video
very nice teaching presentation . is there a specific way to measure the real deployment neck diameter in case of angulation .. i mean how to predict where and how the graft will deploy depending on the stiff wire . and will it make a difference if the wire is from the right or left side?
thanks a lot am very impressed on how you present the data in very interesting way.
Dear Dr. Rashaideh, thank you for the kind words. There is no specific way to measure the real deployment neck diameter in the case of angulation. Thus, the angulated necks are challenging and the poor outcomes of the literature in such necks can be correlated, in my opinion, to wrong oversizing.
In the majority of the cases, the markers will stay at the level of the deployment on the side of the attachment of Lunderquist on the aortic wall. If the endograft is undersized, the proximal markers on the other side will be placed underneath of this level and if the endograft is oversized will stay at that level. It makes also no difference if the wire is from the right side or the left side because this is not something that you can influence. It has to do with the angulation of the neck (right- or left-sided).
In any case, I will suggest going for at least 30% oversizing in angulated necks. If the 30% oversizing indicates an endograft with a diameter between the pre-specified diameters (28, 32, 36) of the available endografts (e.g. 33 mm), select then the endograft with the bigger diameter (36 mm).
Aortic Disease Awareness Day – September 19