10:10 am Opening Ceremony Or. Gary J. Becker Young Investigator Award

Rubin) MDStanford UniversityStanford, CalilforniaUntil approximately 6 years ago, direct surgical repairwas the only treatment available for aortic aneurysms.The recent development of endovascular prostheses orstent-graftsfor the percutaneous treatment of aortic an­eurysms, however, has allowed aneurysm repair in asignificantly broader range ofpatients, particularly thosetoo frail to undergo standard operative repair 0-5).Advantages ofendovascular repair include treatmentunder local or limited epidural anesthesia, lack ofaorticcross-clamping, and brief total aottic occlusion time.Anatomic requirements for stent-graftplacement are de­vice specific and continually evolving. Although endo­vascular repair of abdominal aortic aneurysms (AAAs)was limited to the 10-15%of AAAs with a neck greaterthan 10 mm proximal to the iliac artery bifurcation, theintroduction of bifurcated stent-grafts (3,6-8)and thedevelopment ofa combined single aortoiliac stent-graft,contralateral iliac artery occluder, and surgical femoralartery to femoral artelY bypass (9) broadened the selec­tion criteria for endovascular repair. Complication ratevariations within populations ofAAA are associated withthe morphologic characteristics of the aneurysm (0).Based on an assessment of 168 AAAs, Armon and col­leagues (11) estimated that 131 (80%) were potentiallysuitable for endoluminal repair assuming that 1 of 756possible combinations ofproximal and distal graft diam­eters (2-mmincrements) and graft lengths (in I-emin­crements) are available. Although the measurementtechniques used in this study were limited, the resultsunderscore the marked morphologic variability presentin AAA and the importance of an accurate and repro­ducible method for sizing the aorta and iliac arteriesbefore device deployment. The table lists complicationsthat may occur after endovascular repair of aneurysmsand the quantitative and qualitative features ofthe anat­omy that influences the likelihood of these complica­tions.As a result, the planning ofendovascular treatment ofaortic aneUlysms puts greater requirements on pre­operative imaging than any previous application(1,9,12,18,19), because stent-graftsmust conform to theaortic lumen, and refinement ofvascular measures, graftsizing, and alterations in suturing technique typicallymade under direct visualization in the operating roomare not an option (11).Aortoillac Characterization Before Stent-GraftDeploymentConventional angiography has long been considered thegold standard for vascular imaging. Conventional an­giography is limited, however, by its inability to showthrombosed regions of aneurysms and the effects ofprojection, magnification, and parallax on the accuracyof measurements. Conventional angiography is three orfour times more expensive than computed tomography