Journal article
Does hostile neck anatomy preclude successful endovascular aortic aneurysm repair?
Journal of vascular surgery, v 38(4), pp 657-663
01 Oct 2003
PMID: 14560209
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Poor outcomes have been reported with endovascular aneurysm repair (EVAR) in patients with hostile neck anatomy. Unsupported endografts with active fixation may offer certain advantages in this situation. We compared EVAR results using the Ancure (Guidant) endograft in patients with and without hostile neck anatomy.
Records of EVAR patients from October 1999 to July 2002 at a tertiary care hospital were retrospectively reviewed from a division database. Patients with elective open abdominal aortic aneurysm (AAA) repair during the same period were reviewed to determine those unsuitable for EVAR. Hostile neck anatomy, assessed by computer tomography (CT) scans and angiograms, was defined as one or more of the following: (1) neck length </=10 mm, (2) focal bulge in the neck >3 mm, (3) >2-mm reverse taper within 1 cm below the renal arteries, (4) neck thrombus > or =50% of circumference, and (5) angulation > or =60 degrees within 3 cm below renals.
Three hundred and twenty-two patients underwent EVAR with an average follow-up of 18 months. Patients in Phase II trials (n = 41), repaired with other graft types (n = 48), or without complete anatomic records (n = 27) were excluded. Demographics and co-morbidities were similar in the 115 good-neck (GN) and 91 bad-neck (BN) patients except for age (mean, 72.9 years GN vs 75.7 BN; P = 0.13), gender (11% female GN vs 22% BN; P =.04); neck length (mean, 21.8 mm GN vs 14.4 mm BN: P <.001), and angulation (mean, 22 degrees GN vs 40 degrees BN; (P <.001). Perioperative mortality (0 GN vs 1.1% BN), late mortality (5.2% GN vs 4.4% BN), all endoleaks (19.1% GN vs 17.6% BN), proximal endoleaks (0.8% GN vs 2.1% BN), and graft migration (0 for both groups) did not reach statistical significance. Neck anatomy precluded EVAR in 106 of 165 (64%) patients with open AAA.
Unsupported endografts with active fixation can yield excellent results in treating many medically compromised patients with hostile neck anatomy. Nonetheless, an unsuitable neck remains the most frequent cause for open abdominal AAA.
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Details
- Title
- Does hostile neck anatomy preclude successful endovascular aortic aneurysm repair?
- Creators
- Ellen D Dillavou - University of Pittsburgh Medical CenterSatish C Muluk - University of Pittsburgh Medical CenterRobert Y Rhee - University of Pittsburgh Medical CenterEdith Tzeng - University of Pittsburgh Medical CenterJonathan D Woody - University of Pittsburgh Medical CenterNavyash Gupta - University of Pittsburgh Medical CenterMichel S Makaroun - University of Pittsburgh Medical Center
- Publication Details
- Journal of vascular surgery, v 38(4), pp 657-663
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiothoracic Surgery
- Web of Science ID
- WOS:000185858700005
- Scopus ID
- 2-s2.0-0141885377
- Other Identifier
- 991021944512204721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Peripheral Vascular Disease
- Surgery