Large diameter (≥29 mm) proximal aortic necks are associated with increased complication rates after endovascular repair for abdominal aortic aneurysm

George Kouvelos, Konstantinos Spanos, Petroula Nana, Stylianos Koutsias, Nikolaos Rousas, Athanasios Giannoukas, Miltiadis Matsagkas
Annals of Vascular Surgery 2019 May 7

AIM: To investigate the impact of proximal aortic diameter on outcome after endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms.

METHODS: This was a case-control (1:1) retrospective analysis of prospectively collected data on 732 AAA patients treated with EVAR in two university centers. Patients with an infra-renal neck diameter of 29-32 mm (wide neck-WN group) were compared with patients with a neck diameter of 26-28.9 mm (control group) matched for age, gender, and maximum aneurismal sac diameter. Any patients treated outside the instructions for use of each endograft or with not adequate follow-up were excluded. The primary end-point was any neck-related adverse event (a composite of type Ia endoleak, neck-related secondary intervention, and endograft migration) during follow-up.

RESULTS: 64 patients with a proximal neck diameter of 29-32mm (WN group) were compared with a matched control group of 64 patients with a neck diameter of 26-28.9mm (control group). Oversizing was significantly higher in the study group (17.9% vs. 15.5%, p=0.001). Overall median available follow-up was 24 months (range 12-84 months), (WN group: 24 months vs. control group 18.5 months, p=0.943). Primary end-point was recorded in 8 patients (12.5%) of the WN group and in 1 patient (1.6%) of the control group. Freedom from the primary endpoint at 36 months (SE <10%) was 87.3% for the study vs. 98.4% for the control group (log rank=4.66, p=0.03). On multiple regression analysis, the presence of a proximal aortic neck >29mm was the only independent risk factor for neck related adverse events (OR 7.4; 95% CI 1.2-47.1).

CONCLUSION: EVAR in the presence of a wide proximal aortic neck is likely to be associated with higher adverse neck-related event rates and thus, in such cases closer follow-up may be required.

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