Conical Aortic Neck as a Predictor of Outcome after Endovascular Aneurysm Exclusion: Midterm Results

Nana, Petroula; Spanos, Konstantinos; Kouvelos, George; Αrnaoutoglou, Eleni; Giannoukas, Athanasios D.; Matsagkas, Miltiadis

doi:10.1016/j.avsg.2022.11.004

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…These considerations may justify the relatively low incidence of type IA endoleak and graft migration that were observed in the cohort of patients included in this analysis. Indeed, the efficacy of proximal sealing depends on the combination of several patients-related and graft-related factors, such as neck shape, angulations, calcifications, endoprosthesis fixation (barbs, bare metal stents), and the sole occurrence of 2–3 mm PAN growth from the baseline may be insufficient to cause any clinically relevant proximal neck complications [ 29 , 30 , 31 ]. Although this may represent a potential methodological bias, a continuous growth of the PAN has been well documented in most available literature and lifelong follow-up is recommended both in EVAR and FEVAR procedures, especially when hostile anatomical features of the PAN are present [ 32 ], as also suggested by current clinical practice guidelines [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Mezzetto

D’Oria

Lepidi

et al. 2023

JCM

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Background: To define proximal neck dilation (PND) after standard endovascular aneurysm repair (EVAR) and fenestrated EVAR (FEVAR), determining: incidence and risk factors; evidence base that links PND to outcomes of patients; recurring themes or gaps in the literature. Methods: We performed a scoping review and included only full-text English articles with follow-up focusing on PND in patients undergoing EVAR or FEVAR, published between 2000 and 2022. The following PICO question was used to build the search equation: in patients with abdominal-aortic-aneurysm (AAA) (Population) undergoing endovascular repair (Intervention), what are the incidence, risk factors and prognosis of radiologically defined PND (Comparison) on short-term and long-term outcomes (Outcomes)? Results: 15 articles were included after review. Measurement protocols for proximal aortic neck (PAN) varied among individual studies and the definition of PND resulted as heterogeneous. Rate of patients with a PND ranged between 0% and 41%. Large proximal neck (>28 mm) and excessive graft sizing (30%) were predictors for PND. New endografts with low outward radial forces and FEVAR seemed to be protective. Surgical conversion was the definitive option in the case of patients unfit for other endovascular treatments. Conclusions: PND is a frequent finding after EVAR and FEVAR. Excessive graft oversizing and large baseline PAN were predictors of neck enlargement, independently by the type of standard endograft used. FEVAR may be considered protective against complications, together with endografts using low outward radial forces. Lifelong radiological follow-up is mandatory.

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Section: Discussionmentioning

confidence: 99%

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Mezzetto

D’Oria

Lepidi

et al. 2023

JCM

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“…A conical neck, defined as a neck with ≥10% diameter increase within 15 mm below the lowest renal artery, is a common morphological characteristic encountered in patients with AAA. Other morphological variants, for example, “reverse” conical neck or posterior bulge (colloquially referred to as “double bubble” configuration), pose a challenge in creating a reliable seal with proximal fixation [ 38 , 39 ]. Even though these morphologies fall outside of the IFU for most commercially available devices, a significant proportion of patients with these anatomies are being treated with EVAR [ 14 , 40 ].…”

Section: Hostile Neck Characteristicsmentioning

confidence: 99%

“…One recently published retrospective analysis found no difference between rates of type Ia endoleak and graft migration in conical proximal necks versus non-hostile aortic necks. A subgroup analysis on the conical neck cohort suggested that a more aggressive oversizing strategy provided a protective benefit on graft migration, albeit not statistically significant [ 39 ]. The degree of oversizing is not clearly defined in these cases, particularly as the definition of proximal neck diameter in these anatomies varies.…”

Section: Hostile Neck Characteristicsmentioning

confidence: 99%

The Challenge of Treating Abdominal Aortic Aneurysms with Hostile Neck Anatomy: An Overview

Houser,

Martinez,

Tassiopoulos

2024

JCM

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Hostile aortic neck anatomy challenges the outcomes of endovascular abdominal aortic aneurysm repair (EVAR). Besides reverting to open surgical repair (OSR), thoughtful endograft selection and a number of advanced endovascular techniques have been suggested as potential solutions for preventing proximal seal zone complications, improving EVAR durability, and preventing aneurysm-related death. Each technique is associated with advantages and limitations and there has not been a credible direct comparison amongst them in the form of a well-designed prospective trial. The not infrequent presence of multiple hostile anatomic characteristics further complicates decision making and challenges the surgeon’s skills. This paper serves as an overview of hostile neck anatomy and its implications on EVAR. We provide a concise literature review with the purpose of outlining the treatment modalities and outcomes in this patient population.

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The real-world incidence and predictors of sac regression in patients with infrarenal abdominal aortic aneurysm after standard EVAR

Ding,

Zhou,

et al. 2024

Asian Journal of Surgery

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Conical Aortic Neck as a Predictor of Outcome after Endovascular Aneurysm Exclusion: Midterm Results

Cited by 6 publications

References 25 publications

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

The Challenge of Treating Abdominal Aortic Aneurysms with Hostile Neck Anatomy: An Overview

The real-world incidence and predictors of sac regression in patients with infrarenal abdominal aortic aneurysm after standard EVAR

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