A systematic review of standardized methods for assessment of endograft sealing on computed tomography angiography post-endovascular aortic repair, and its influence on endograft-associated complications

Richte C.L. Schuurmann*, Philippe M. De Rooy, Frederico Bastos Gonçalves, Cornelis G. Vos, Jean Paul P.M. De Vries

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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Introduction: Although there is much attention for proper sizing of pre-operative anatomy before (thoracic) endovascular aneurysm repair ([T]EVAR), standardized assessment of endograft position and apposition at postoperative imaging is seldom addressed in the international guidelines. The highly detailed three-dimensional computed tomography angiography (CTA) volumes contain valuable information about the apposition of the endograft with the arterial wall and the position of the device relative to anatomical landmarks in the proximal and distal landing zones, which is currently hardly used. With proper assessment on CTA of the endograft after EVAR, the risk for future endograft-related complications may be determined, allowing patient-tailored, risk-stratified surveillance. Areas covered: This systematic review identified three standardized methods for assessing apposition or position of the endograft in the proximal or distal landing zone on CTA after (T)EVAR. Quantification of apposition and position, validation of measurement precision, and association with endograft-related complications were extracted. Short (<10 mm apposition length) and decreasing (>0 mm) apposition were associated with endograft-associated complications. Expert commentary: Standardized assessment of apposition and position of the endograft in the proximal and distal landing zones on CTA should be incorporated in post-(T)EVAR surveillance. A risk-stratified CTA surveillance protocol is proposed.

Original languageEnglish
Pages (from-to)683-695
Number of pages13
JournalExpert review of medical devices
Issue number8
Publication statusPublished - 3 Aug 2019



  • abdominal aneurysm
  • computed tomography angiography
  • endovascular aneurysm repair
  • image reconstruction
  • practice guidelines
  • stentgraft
  • Systematic review
  • thoracic endovascular aortic repair

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