Assessing and minimizing risk of patients with aortic disease

Prophylactic endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) aims to avoid aneurysm rupture. However, only patients with sufficient long-term survival get benefit from this avoidance. Therefore, accurate patient selection is crucial.
The aim of the project is to evaluate new methods of assessing and minimizing the risks and thereby improve the selection of patient with the most long-term benefit from prophylactic EVAR.
The specific aims of this thesis were:
• Evaluate if ilio-femoral calcium score measured on preoperative computed tomography is associated with survival after EVAR of varied complexity, with particular focus on cardiovascular events.
• Evaluate if combining ilio-femoral calcium score to the Glasgow Aneurysm Score (GAS) improves the prediction of long-term survival in patients undergoing infrarenal EVAR.
• Investigate if preoperative assessment of long-term survival in patients undergoing infrarenal EVAR can be improved by measuring the ileo-psoas muscle size and visceral adipose tissue on preoperative CT angiography.
• Explore and create a standardized protocol of CO2-angiography during EVAR in a multicenter setup.
• Evaluate a protocol based on the preferential use of automated CO2-angiography during fusion-guided IBD implantation.
Conclusions
Low ilio-femoral calcium score may be associated with lower incidence of fatal cardiac events and all- cause long-term mortality after EVAR of varied complexity. The preoperative assessment of the long- term survival of patients undergoing infrarenal EVAR can be done with the clinically based Glasgow Aneurysm Score. This can potentially be refined in low-risk patients by measuring and adding the ilio- femoral calcium score. CT-based assessment of the ileo-psoas muscle size and visceral adipose tissue did not contribute to improve the prediction of long-term survival after EVAR.
A CO2-EVAR operative protocol was developed and this protocol enabled all involved centers to accomplish EVAR procedures using minimal amounts of iodine contrast. Reduction of intraoperative iodine contrast exposure during IBD implantation is feasible through the predominant use of automated CO2-angiography. This can be safely done without affecting the technical success or radiation exposure, but this did not have an impact on the postoperative renal function.