OBJECTIVETo study the assessment and management for abdominal aortic aneurysm (AAA)'s special distal landing zones in endovascular repair (EVAR).

METHODSThe clinic data of 66 AAA patients with complicated distal landing zones From January 2007 to December 2010 was retrospectively analyzed. There were 45 male and 21 female patients, aged from 53 to 87 years with a mean of 62 years. All patients underwent the CT angiography examination (1 to 2 mm interval) to obtain the necessary anatomical data. In this group, there were 20 cases with type I and IIA lesions, including 10 cases with narrow common iliac arteries/external iliac arteries (> 50%), 6 cases with seriously distorted common iliac arteries/external iliac arteries, 4 cases with the characters of the above, 16 cases with bilateral common iliac aneurysms, 46 cases with bilateral common iliac aneurysms combined internal iliac aneurysms (unilateral 32 cases, bilateral 14 cases). The vascular stent-grafts' usage was as follow: Metronic 46 cases, COOK 14 cases, Microport 4 cases, Lifetech 2 cases.

RESULTSThe mean operative time was 90 min. There were significant stent-graft shortening in 22 cases (33.3%), type II endoleak in 18 cases (27.3%), type III endoleak in 5 cases (7.6%), iliac stents' stenosis (> 50%) in 2 cases (3.0%), type II combined with type III endoleak in 5 cases (7.6%), iliac stents' stenosis combined with type III endoleak in 4 cases (6.1%). Patients were followed for a mean of 22 months (range from 3 to 36 months), during the time of follow-up, the following conditions were observed: stent-graft displacement (to the remote < 10 mm) in 2 cases (3.0%), iliac stents restenosis (> 50%) 2 cases, type II endoleak healed in 18 cases (18/23, 78.3%), and no type III endoleak remained. The fatality rate was 3.0% (2/66).

CONCLUSIONSSpecial distal landing zones increased the operative complication rate in EVAR. Being familiar with the features of stent-graft and appropriate use of various surgical management can increase the success ratio of EVAR.