Impact of aortoiliac tortuosity on endovascular repair of abdominal aortic aneurysms: Evaluation of 3D computer-based assessment Yehuda G. Wolf, Manfred.

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Impact of aortoiliac tortuosity on endovascular repair of abdominal aortic aneurysms: Evaluation of 3D computer-based assessment Yehuda G. Wolf, Manfred Tillich, W.Anthony Lee, Geoffrey D. Rubin, Thomas J. Fogarty, Christopher K. Zarins Journal of Vascular Surgery Volume 34, Issue 4, Pages 594-599 (October 2001) DOI: 10.1067/mva.2001.118586 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Examples of increased tortuosity. A, The most tortuous common iliac artery with a “hair pin” configuration evaluated in a patient who underwent endovascular aneurysm repair. B, A transverse proximal aortic neck in a 92-year-old woman, which could not be cannulated. The patient underwent an uneventful open aneurysm repair. C, Tortuous iliac arteries, typical of advanced age, in an 86-year-old patient who underwent an uneventful endovascular aneurysm repair. D, An aneurysm considered too tortuous for endovascular repair. Notice the left common iliac artery with an acute angulation just below the aortic bifurcation. Journal of Vascular Surgery 2001 34, 594-599DOI: (10.1067/mva.2001.118586) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Maximum-intensity projection of an infrarenal aortic aneurysm and common iliac arteries. The dashed line represents the MLC. MLC–straight line ratio consisted of the length of the MLC from A to B divided by the length of the straight line between these two points. A potential source of overestimation of tortuosity within the aneurysm is shown. Because of its dependence on aneurysm configuration, the MLC may follow an angulated course (arrows ) that is unrelated to the course hardware traversing the aneurysm. This type of angulation is related to the construction of the MLC and is more accentuated in eccentric and saccular flow patterns within the aneurysm. Journal of Vascular Surgery 2001 34, 594-599DOI: (10.1067/mva.2001.118586) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Scattergram of age against aortoiliac tortuosity index. The values are widely scattered (r = 0.38, P =.004), but a general trend toward increasing tortuosity with age is noticeable. Journal of Vascular Surgery 2001 34, 594-599DOI: (10.1067/mva.2001.118586) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions