Conical neck is strongly associated with proximal failure in standard endovascular aneurysm repair

• Published in: Journal of vascular surgery 2017-12, Vol.66 (6), p.1686-1695
• Main Authors: Pitoulias, Georgios A., MD, PhD, Valdivia, Andrés Reyes, MD, FEBVS, Hahtapornsawan, Suteekhanit, MD, Torsello, Giovanni, MD, PhD, Pitoulias, Apostolos G., MD, Austermann, Martin, MD, Gandarias, Claudio, MD, PhD, Donas, Konstantinos P., MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - surgery; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Computed Tomography Angiography; Endoleak - diagnostic imaging; Endoleak - etiology; Endoleak - mortality; Endoleak - therapy; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Europe; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Prosthesis Design; Retreatment; Retrospective Studies; Risk Factors; Stents; Surgery; Time Factors; Treatment Failure
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2017.03.440

Abstract Objective Hostile proximal aortic neck (HN) challenges the suitability for standard endovascular aneurysm repair (EVAR) of patients at high risk for “open” repair. However, there has been little if any focus placed on the individual role of the “nonlength” HN features in EVAR outcomes. The aim of this study was to evaluate their individual and potentially predictive role in outcomes of EVAR under HN conditions. Methods Data of 156 consecutive EVAR patients with short (32 mm or bulge, angulation >60 degrees, reverse taper anatomy, and circumferential thrombus or calcification >50%) and underwent standard EVAR without additional techniques, such as use of chimney grafts or endoanchors. Primary end points were absence of type Ia endoleak at 1 month and midterm follow-up and aneurysm sac stabilization or shrinkage. Secondary end points were 30-day mortality, overall survival, and secondary interventions related to EVAR. The study cohort was classified in two subgroups related to neck length (length 32 mm, angulation >60 degrees, and calcification or thrombus were not assoc