A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy

Abstract

Insufficient high-level evidence for or against performing standard EVAR in patients with hostile neck anatomy exists. Our analysis suggests EVAR should be cautiously used in patients with anatomic neck constraints.

Outcomes of EVAR with the endurant stent-graft system in patients with infrarenal ruptured abdominal aortic aneurysms: Is hostile anatomy a challenging factor?

“…Stather et al [19] stated that there was no difference in aneurysmrelated mortality between normal and hostile anatomy groups with unruptured AAAs. However, aneurysm-related mortality within 1 year after the procedure was found to have a 9-fold increase in the hostile anatomy group with unruptured AAAs, according to Antoniou et al [3].…”

“…Antoniou et al [3] showed that patients with hostile anatomy (714 patients) had a 4-fold increased risk of developing a Type 1 endoleak in unruptured AAAs in a metaanalysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. But in that study five different endografts systems which were oldly designed were used in most of the patients and in few patients Endurant was the chosen stent-graft.…”

“…Skepticism exists with regard to the safety and efficacy of this practice. There is insufficient high-level evidence in favor of or against performing standard endovascular aneurysm repair (EVAR) in patients with hostile neck anatomy [3][4][5].…”

Midterm Re-interventions and Survival After Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysm

“…In elective aortic repair, patients treated outside the IFU have a higher risk of adverse events. 21 For this reason, the midterm re-intervention rates in the Amsterdam region were probably low compared with hospitals pushing the anatomical limits of EVAR for RAAAs.…”

Commentary: New-Generation Devices and Adjunctive Procedures Are the Key Elements to Expanding the Indications for Endovascular Aneurysm Repair

“…3 However, there is insufficient high-level evidence for or against performing standard EVAR in patients with hostile neck anatomy. 4 Additionally, despite improvements in endovascular techniques, problematic iliac access is a recurrent cause for exclusion from EVAR. Moreover, access-related complications continue to be a problem; in particular, small and calcified iliac vessels represent a major source of perioperative complications.…”