Supong Worathanmanon¹, Wittawat Tantarattanapong¹, Boonprasit Kritpracha¹, Pong Jantarapatin¹, Dhanakom Premprapha¹, Sorracha Rookkapan²

Objective: To comprehensively characterize the aortoiliac segment in Thai patients with abdominal aortic aneurysms (AAAs) and to assess the suitability of employing endovascular aneurysm repair (EVAR) across different stent-graft devices.

Materials and Methods: Electronic medical records of AAA patients eligible for treatment between January 2014 and August 2020, drawn from the Songklanakarin Hospital database, were systematically analyzed. Preoperative assessments of whole aorta CT angiograms were conducted using ‘Endosize’ software, scrutinizing various anatomical parameters. The suitability of eight FDA-approved stent devices for EVAR was determined based on stringent criteria.

Results: Distinct variations in aortoiliac morphology were identified in the Thai population, deviating from characteristics observed in Western populations. Notably, these variances included smaller dimensions overall, juxtaposed with a marginally larger maximum aneurysm diameter. Key measurements encompassed suprarenal and infrarenal angles of 28 and 45.6 degrees, neck diameter and length of 21.1 and 25.3 mm, maximum aneurysm diameter of 62.8 mm, and aortic bifurcation at 29.7 mm. Common iliac artery dimensions featured diameters of 12.7 and 13 mm, coupled with lengths of 52.8 and 54.4 mm. Femoral artery diameters were recorded at 7.1 and 7.2 mm. Stent-graft compatibility exhibited variability, ranging from 24.9% to 67%, with Ovation® demonstrating the highest compatibility and AFX® the lowest. Common iliac length demonstrated greater compatibility, in contrast to diminished compatibility associated with larger neck and common iliac diameter requirements.

Conclusion: The present investigation uncovered distinctive morphological features within the aortoiliac segment of the Thai population, thereby contributing to the observed variations in EVAR compatibility across different stent-graft manufacturers. The results underscore the pivotal role of ethnicity as a crucial determinant in vessel morphology, with implications that hold particular relevance for the ongoing design and development of stent-grafts. The unique insights derived from the present study enhance understanding of population-specific anatomical considerations, thereby enriching the field of vascular surgery.

Received 16 September 2024 | Revised 26 October 2024 | Accepted 14 November 2024

DOI: 10.35755/jmedassocthai.2025.1.65-71-01430