The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients

AbuRahma, Ali F.; Campbell, John E.; Stone, Patrick A.; Nanjundappa, Aravinda; Jain, Akhilesh; Dean, Larry S.; Habib, Joseph; Keiffer, Tammi; Emmett, Mary

doi:10.1016/j.jvs.2009.04.061

Cited by 174 publications

(134 citation statements)

References 21 publications

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“…18) The suitability for EVAR is usually based on the manufacturer's IFU, which require that certain standards be fulfilled to ensure a better outcome. 19) In particular, unfavorable anatomy of the proximal aortic neck is responsible for the exclusion of about 60% of the patients who would otherwise be treated by EVAR. 18) As the indications for EVAR continue to expand, the number of patients outside of the IFU continues to grow as well.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use

Igari

Kudo

Toyofuku

et al. 2014

Ann Thorac Cardiovasc Surg

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Section: Discussionmentioning

confidence: 99%

Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use

Igari

Kudo

Toyofuku

et al. 2014

Ann Thorac Cardiovasc Surg

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“…5) Some large studies that examined EVAR outcomes showed that the most common factors causing a poor outcome were short neck and severe neck angulation. [3][4][5] Massive neck atheroma was also shown to affect EVAR outcome when compared to the outcome of open surgery. 6) In our study, device oversizing did not occur.…”

Section: Methodsmentioning

confidence: 99%

“…In some studies on the results of EVAR outside of IFU, aneurysmal neck factors (short length, severe angulation, and presence of massive atheroma) are commonly reported to cause EVAR-related adverse events. [3][4][5][6] Feasibility of Endovascular Abdominal Aortic Aneurysm Repair Outside of the Instructions for Use and Morphological Changes at 3 Years after the Procedure neck atheroma, even in the presence of a type 1a endoleak.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Endovascular Abdominal Aortic Aneurysm Repair Outside of the Instructions for Use and Morphological Changes at 3 Years after the Procedure

Hoshina

Hashimoto

Kato

et al. 2014

Annals of Vascular Diseases

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Introduction:We retrospectively analyzed outcomes of patients who had undergone endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) more than 3 years previously in a single institution. We compared outcomes between patients who underwent EVAR within and outside of the devices' instructions for use (IFU) and examined mid-term morphological changes in AAA. Methods: A total of 275 patients who underwent EVAR for AAA were selected. IFU parameters included aneurysmal neck length, angulation and presence of massive atheroma. Patients were divided into 2 groups: the Within IFU group (W-IFU: n = 193) and the Outside of IFU group (O-IFU: n = 82). Results: Patients in the O-IFU group were older and had a larger AAA diameter. Other comorbid factors were similar between the 2 groups. There was no difference in overall survival rates and reintervention rates between the 2 groups. The most common cause for reintervention was AAA enlargement 3 years after EVAR. Irrespective of the IFU, mid-term morphological changes, including neck angulation, neck diameter, sac re-expansion, and Palmaz stent displacement, were found. Conclusion: Outcomes of EVAR were considered acceptable in the O-IFU group. Careful follow-up is necessary considering the morphological changes in AAAs after EVAR.

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“…Upwards of 30% of patients with AAAs have unsuitable proximal neck morphology for conventional endovascular repair (4)(5)(6)(7). Anatomies considered unsuitable for conventional infrarenal stent grafting include short or absent necks, angulated necks, conical necks, or large necks exceeding size availability for current stent grafts.…”

Section: Technical Challengesmentioning

confidence: 99%

Advanced endografting techniques: snorkels, chimneys, periscopes, fenestrations, and branched endografts

Kansagra¹,

MD²,

Taon³

et al. 2018

Cardiovasc. Diagn. Ther.

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The anatomy of aortic aneurysms from the proximal neck to the access vessels may create technical challenges for endovascular repair. Upwards of 30% of patients with abdominal aortic aneurysms (AAA) have unsuitable proximal neck morphology for endovascular repair. Anatomies considered unsuitable for conventional infrarenal stent grafting include short or absent necks, angulated necks, conical necks, or large necks exceeding size availability for current stent grafts. A number of advanced endovascular techniques and devices have been developed to circumvent these challenges, each with unique advantages and disadvantages. These include snorkeling procedures such as chimneys, periscopes, and sandwich techniques; "homemade" or "back-table" fenestrated endografts as well as manufactured, customized fenestrated endografts; and more recently, physician modified branched devices. Furthermore, new devices in the pipeline under investigation, such as "off-the-shelf" fenestrated stent grafts, branched stent grafts, lower profile devices, and novel sealing designs, have the potential of solving many of the aforementioned problems. The treatment of aortic aneurysms continues to evolve, further expanding the population of patients that can be treated with an endovascular approach. As the technology grows so do the number of challenging aortic anatomies that endovascular specialists take on, further pushing the envelope in the arena of aortic repair.

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The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients

Abstract: EVAR can be used for patients with a short aortic neck; however, it was associated with a significantly higher rate of early and late type I endoleaks, resulting in an increased use of proximal aortic cuffs for sealing the endoleaks.

Cited by 174 publications

References 21 publications

Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use

Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use

Feasibility of Endovascular Abdominal Aortic Aneurysm Repair Outside of the Instructions for Use and Morphological Changes at 3 Years after the Procedure

Advanced endografting techniques: snorkels, chimneys, periscopes, fenestrations, and branched endografts

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