Results of endovascular repair of abdominal aortic aneurysms with an unfavorable proximal neck using large stent-grafts.
The purpose of this study was to evaluate the early outcome of endovascular repair of abdominal aortic aneurysms (EVAR) with an unfavorable neck anatomy using extralarge stent-grafts. We carried out a retrospective review of all patients who underwent elective EVAR using large diameter stent-grafts between June 2006 and February 2008. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. All patients were followed up with CTA at 3 and 12 months and annual duplex thereafter when appropriate. This analysis included 25 patients (23 men, 2 woman; median age, 76 years; age range, 60-88 years). The median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Extralarge Cook-Zenith stent-grafts were used in all patients, with a top-end diameter of 36 mm (n=23) and 40 mm (n=2). The follow-up period ranged from 3 to 24 months, with a median of 6 months. Primary and assisted primary technical success rates were 80% and 96%, respectively. Reintervention was required to treat proximal type I endoleak (n=1), iliac limb kink (n=2), and occluded femorofemoral crossover graft (n=1). These early results show that EVAR using extralarge stent-grafts with suprarenal fixation can be a reliable modality to treat infrarenal aortic aneurysms with an unfavorable neck anatomy.
Zayed
Hany A
HA
Department of Vascular Surgery, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
Bell
Rachel E
RE
Clough
Rachel E
RE
Thomas
Stephen
S
Sabharwal
Tarun
T
Reidy
John F
JF
Carrell
Tom W
TW
Taylor
Peter R
PR
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome