title: Midterm results of adjunctive neck therapies performed during elective infrarenal aortic aneurysm repair.
abstract: OBJECTIVE
  This study evaluated the durability of adjunctive endovascular neck procedures, including aortic cuffs, Palmaz stents (Cordis, Miami Lakes, Fla), and high-pressure balloon angioplasty, at managing intraoperative proximal neck complications during endovascular aortic aneurysm repair (EVAR).
  
  
  METHODS
  This was a single-center retrospective review of EVARs. The primary outcome variable studied was survival free of a graft-related event (GRE). GRE was defined by the occurrence of one of the following: type I endoleak, sac enlargement, aneurysm rupture, death, or procedure related to the aortic neck. These outcome variables were assessed relative to the preoperative anatomic neck variables (neck length, diameter, degree of angulation, degree of circumferential thrombus, and presence of conicity), procedural variables (manufacturing type of graft, use of a Palmaz stent), and patient characteristics (age and presence of medical comorbidities). Outcomes were assessed by t tests, Pearson χ(2), and Kaplan-Meier analysis, when appropriate.
  
  
  RESULTS
  A total of 174 EVARs performed between January 2005 and December 2007 were evaluated. Fifty-six adjunctive procedures were performed, with a 97% primary-assisted exclusion rate. Patients who received an adjunctive therapy had similar freedom from a GRE compared with EVARs that did not require adjunctive therapy (35.5 ± 2.6 vs 34.8 ± 1.5 months, P = .31, log-rank test). Subset analysis identified a significant association between Palmaz stent placement at the time of EVAR and decreased freedom from GREs (hazard ratio, 2.87; 95% confidence interval, 1.21-6.77; P = .02).
  
  
  CONCLUSIONS
  Midterm results suggest that adjunctive therapies to manage intraoperative proximal neck complications do not compromise durability. The subset of patients requiring aortic neck Palmaz stent placement at the time of EVAR are among those at highest risk for subsequent GRE.
authors.affiliation: Department of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA.
authors.forename: Jayer
authors.initials: J
authors.lastname: Chung
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Corriere
authors.forename: Ross
authors.initials: R
authors.lastname: Milner
authors.forename: Karthikeshwar
authors.initials: K
authors.lastname: Kasirajan
authors.forename: Atef
authors.initials: A
authors.lastname: Salam
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Dodson
authors.forename: Elliott L
authors.initials: EL
authors.lastname: Chaikof
authors.forename: Ravi Kumar
authors.initials: RK
authors.lastname: Veeraswamy
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D017558:Elective Surgical Procedures; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures; D005260:Female; D006085:Graft Survival; D006801:Humans; D007431:Intraoperative Complications; D053208:Kaplan-Meier Estimate; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed