title: Endovascular repair of abdominal aortic aneurysms in patients with severe angulation of the proximal neck using a flexible stent-graft: European Multicenter Experience.
abstract: OBJECTIVE
  The aim of this paper was to report the results of a multicenter study on endovascular repair of abdominal aortic aneurysms (AAA) in patients with important angulation of proximal neck using a flexible stent-graft (Aorfix).
  
  
  METHODS
  Endovascular repair of AAA using a flexible stent-graft was performed at 16 centers in 29 patients with angulation of proximal neck greater than 45 degrees. Twenty-three patients (79%) had angulation greater than 60 degrees and were therefore contraindicated for repair with other contemporary devices.
  
  
  RESULTS
  Technical success was achieved in all but one case (96%). There was one postoperative death due to multiorgan failure following revision of groin wound for hemorrhage. No patients were converted to open repair. One patient had persisting proximal endoleak despite placement of proximal extension. One patient in whom wireform fractures had been detected died from ruptured aneurysm at nearly 4 year follow-up.
  
  
  CONCLUSIONS
  Endovascular repair using a flexible stent-graft is feasible in patients with highly angulated necks. This stent-graft allows the possibility of a to offer repair for patients un-suitable for the currently available commercial grafts. Mid-term results are acceptable and need to be confirmed by longer follow-up and larger series.
authors.affiliation: Vascular Surgery Department, Hôpital Robert Debré, Reims, France. jnalbertini@chu-reims.fr
authors.forename: J N
authors.initials: JN
authors.lastname: Albertini
authors.forename: T
authors.initials: T
authors.lastname: Perdikides
authors.forename: C V
authors.initials: CV
authors.lastname: Soong
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: M
authors.initials: M
authors.lastname: Trojanowska
authors.forename: S W
authors.initials: SW
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology* / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000517:prevention & control; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005060:Europe; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design / Q000295:instrumentation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome