Outcomes of endovascular aneurysm repair in patients with hostile neck anatomy

P. W. Stather, R. D. Sayers, A. Cheah, J. B. Wild, M. J. Bown, E. Choke

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Objectives: This study aims to evaluate outcomes following EVAR in patients with hostile neck anatomy (HNA).

Methods: Data prospectively collected from 552 elective EVARs were analysed retrospectively. Data regarding neck morphology was obtained from aneurysm stent plans produced prior to EVAR. HNA was defined as any of; neck diameter >28 mm, neck angulation >60°, neck length <15 mm, neck thrombus, or neck flare.

Results: 552 patients underwent EVAR. Mean age 73.9 years, mean follow-up 4.1 years. 199 patients had HNA, 353 had favourable neck anatomy (FNA).
There was a significant increase in late type I endoleaks (FNA 4.5%, HNA 9.5%; P = 0.02) and total reinterventions (FNA 11.0%, HNA 22.8%; P < 0.01), and a significant decrease in late type II endoleaks in patients with HNA (FNA 16.7%, HNA 10.6%; P < 0.05).
There was no significant difference in technical success (FNA 0.6%, HNA 2.0%; p = 0.12), 30-day re-intervention (FNA 2.8%, HNA 5.0%; P = 0.12), 30-day mortality (FNA 1.1%, HNA 0.5%; P = 0.45), 30-day type I endoleaks (FNA 0.8%, HNA 2.5%; P = 0.12), 5-year mortality (FNA 15.1%, HNA 14.6%; P = 0.86), aneurysm-related mortality (FNA 1.7% versus HNA 2.0%; P = 0.79), stent-graft migration (FNA 2.5%, HNA 3.0%; P = 0.75), sac expansion (FNA 13.0%, HNA 9.5%; P = 0.22), or graft rupture (FNA 1.1%, HNA 3.5%; P = 0.05).
Binary logistic regression of individual features of HNA revealed secondary intervention (P = 0.009), technical failure (P = 0.02), and late type I endoleaks (P = 0.002), were significantly increased with increased neck diameter.

Conclusions: HNA AAAs can be successfully treated with EVAR. However, surveillance is necessary to detect and treat late type I endoleaks in HNA patients.
Original languageEnglish
Pages (from-to)556-561
Number of pages6
JournalEuropean Journal of Vascular and Endovascular Surgery
Issue number6
Publication statusPublished - Dec 2012

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