Explaining endograft shortening during endovascular repair of abdominal aortic aneurysms in severe aortoiliac tortuosity

Abstract Objective During endovascular aneurysm repair (EVAR), severely tortuous aortoiliac anatomy can alter the deployment and conformability of the endograft. The accuracy of treatment length measurements is commonly recognized to be affected by severe tortuosity. However, the exact mechanism of the postintervention length discrepancy is poorly understood. The objective of this study was to determine the mechanism of how severe aortoiliac tortuosity influences the endograft and native aorta during EVAR and its impact on the distal sealing zone. Methods A prospectively collected vascular surgery database was retrospectively reviewed at a university-affiliated medical center to identify the study patients. Patients who underwent EVAR with the main body device deployed on the side of the severely tortuous iliac artery were selected. Severe aortoiliac tortuosity was defined as having either aortoiliac or common iliac angulation