title: Endovascular abdominal aortic aneurysm repair in 144 patients: correlation of aneurysm size, proximal aortic neck length, and procedure-related complications.
abstract: OBJECTIVE
  During endovascular abdominal aortic aneurysm (AAA) repair, larger aneurysms often present formidable anatomic challenges to the insertion of the delivery catheter and graft deployment. The authors sought to evaluate whether large-diameter aneurysms and those with short proximal aortic necks might be associated with a higher frequency of insertion-related and short-term complications.
  
  
  METHODS
  From October 1999 to August 2000, 144 patients underwent elective endovascular graft placement for infrarenal AAA disease at the authors' institution. These patients were treated with use of the AneuRx bifurcated endoprosthesis. AAA size (maximum aneurysm diameter) and proximal aortic neck length were compared to estimated blood loss, operative time, accuracy of graft placement, presence of endoleak, intraoperative and postoperative complications (such as limb occlusion or vascular injury), length of hospital stay, and mortality. Statistical methods included correlation analysis and logistic regression.
  
  
  RESULTS
  There were 121 men and 23 women whose aneurysms ranged in size from 3 cm to 9.8 cm (mean, 5.6 cm; 95% CI, 5.4-5.8 cm). Endograft insertion was successful in all cases. There were three deaths within 30 days (2.1%) and seven deaths overall (4.9%). There were 43 intraoperative complications (29.9%) in 31 patients (21.5%), most of them minor. Patients with major intraoperative complications had significantly longer procedure times than those without complications (337 vs. 149 min; P <.0001). In the postoperative period (within 30 days), 31 complications (21.5%) occurred in 28 patients (19.4%), again most of them minor. AAA size was unrelated in any way to the rate of complications, but short proximal aortic neck length was associated with more serious intraoperative and postoperative complications (P =.0404 and P =.0230, respectively), and decreased 30-day and overall survival (P =.0240 and P =.0152, respectively).
  
  
  CONCLUSIONS
  Endovascular repair of large AAAs can be challenging; however, the size of the AAA does not influence the rate of complications. A short proximal aortic neck is the only significant risk factor for more serious complications.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA. hovsepiand@mir.wustl.edu
authors.forename: D M
authors.initials: DM
authors.lastname: Hovsepian
authors.forename: A N
authors.initials: AN
authors.lastname: Hein
authors.forename: T K
authors.initials: TK
authors.lastname: Pilgram
authors.forename: D T
authors.initials: DT
authors.lastname: Cohen
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
authors.forename: L A
authors.initials: LA
authors.lastname: Sanchez
authors.forename: B G
authors.initials: BG
authors.lastname: Rubin
authors.forename: D
authors.initials: D
authors.lastname: Picus
authors.forename: G A
authors.initials: GA
authors.lastname: Sicard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013997:Time Factors