Anatomic Criteria for Endovascular Aneurysm Repair

Standard Anatomic Requirements

The American College of Radiology recommends a neck length of ≥10-15 mm for adequate proximal seal, a neck diameter of <30 mm for adequate proximal graft seal, and <90% circumferential coverage of the proximal neck diameter to reduce the risk of type I endoleak and migration 1, 2, 3
The location of the distal landing zone should be within one or both common iliac arteries, with adequate iliac artery diameter and tortuosity to accommodate the delivery system 1, 2

The American Heart Association recommends against using conventional EVAR devices outside IFU in severely angulated necks due to increased failure risk, as demonstrated by long-term studies showing increased risk of aneurysm sac enlargement 4
The American College of Radiology suggests using 3-D multiplanar reformatted images to measure aortic diameter perpendicular to the vessel centerline, rather than axial plane measurements, to avoid overestimating diameter in tortuous anatomy 5

The American College of Cardiology recommends preoperative planning with CT angiography to confirm diameters and detail anatomy when AAA reaches intervention threshold [4, 6, 7 is ignored in favor of 4 and 6]
The European Society of Cardiology states that relying on angiography alone for AAA size assessment is inappropriate 4, 6

The European Society of Cardiology recommends post-EVAR imaging at 1 month and 12 months, then yearly with CT/MR and duplex ultrasound, due to higher complication and reintervention rates compared to open repair 8
The American College of Radiology suggests lifelong monitoring due to higher complication and reintervention rates compared to open repair 1, 2, 3