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. 2016 Jun;121(6):528-35.
doi: 10.1007/s11547-016-0620-y. Epub 2016 Feb 4.

Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

Paolo Cerini  1 , Giuseppe Guzzardi  2 , Ignazio Divenuto  2 , Giuseppe Parziale  2 , Piero Brustia  3 , Alessandro Carriero  2 , Rita Fossaceca  2
Affiliations

Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

Paolo Cerini et al. Radiol Med. 2016 Jun.

Abstract

Objective: To evaluate the effectiveness of endovascular treatment of abdominal aortic aneurysms with hostile neck, comparing the results with those of patients with ideal anatomical conditions.

Materials and methods: From January 2005 to December 2013, 300 patients were treated with EVAR at our institution. Patients with a prior Angio-CT scan were included in the study and they were then retrospectively divided into two groups: patients with suitable anatomy that were treated within guidelines of the manufacturers (wIFU: 94 patients, four treated in emergency) and those with unsuitable anatomy that were treated outside of said guidelines (oIFU: 70 patients, 16 treated in emergency). Patients without prior CT study and without follow-up were excluded from the study.

Results: Postoperative mortality was 6.3 % in the wIFU group while it was 7.8 % in the oIFU group. There was not a statistically significant difference in the rate of postoperative mortality (p = 0.653). Technical success was 98.6 % in the wIFU group while it was 94.5 % in the oIFU group. All the patients of the wIFU group were treated with a stent-graft with under-renal sealing while in the oIFU group always an over-renal stent-graft was used. No deaths related to the aneurysm were highlighted at follow-up in both groups. There was a statistically significative difference between the two groups regarding intraoperative occlusion of renal arteries (wIFU = 1.1 %; oIFU = 4.7 %; p < 0.05) and in the development of type I endoleak (wIFU = 2.8 %; oIFU = 8.8 %; p < 0.05) CONCLUSION: EVAR in patients with hostile neck is feasible and effective with an acceptable rate of complications.

Keywords: AAA; EVAR; Endoprosthesis; Endovascular treatment.

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