title: Abdominal aortic aneurysms with short proximal neck: comparison between standard endograft and open repair.
abstract: OBJECTIVE
  Comparing the results of the treatment of abdominal aortic aneurysms (AAA) with infra-renal neck length ≤1 cm with open repair (OR) and with endovascular treatment (EVAR) with standard endograft.
  
  
  METHODS
  Patients treated from January 2005 to December 2009 for infra-renal AAA with neck length ≤1 cm, were prospectively included. The choice of treatment was made up on anatomical and clinical criteria. Cases treated with OR (G1) and EVAR (G2) were compared. Primary end-points were: peri-operative mortality/morbidity and re-interventions, renal function worsening at discharge, mortality and re-interventions during follow-up. Secondary end points were: procedure time, need and time of intensive unit care (IUC) hospitalization, need for blood transfusions and hospital days. The comparison between groups was estimated by the Long-rank test.
  
  
  RESULTS
  Eighty-two patients were treated (76 males and 6 females); the mean age was 71.4 years (range 56-86) and the mean AAA diameter was 6.2 cm. Forty-four patients were enrolled in G1 and 38 in G2. The two groups were clinically homogeneous, except for: age (G1<G2: P<0.001), chronic obstructive pulmonary disease (COPD) (G1<G2: P=0.016) and obesity (G1<G2: P=0.045). The mean follow-up was 26 months (range 1-63.6). The overall operative mortality was 3.7%: all deaths (3 cases) occurred in G1 (6.8%) while no deaths occurred in G2 (P=NS). The association of peri-operative morbidity and mortality was higher in G1 (P=0.012). There were 7 peri-operative re-interventions, 4 in G1 (9%) and 3 in G2 (7.8%) (P=NS). There was no statistical difference in renal function worsening at discharge between the two groups. At 36 months overall survival was 84% and the survival of G1 and G2 was respectively 80.5% and 87.4% (P=NS). At 36 months, freedom from re-intervention was 82.6% in G1 and 88.4% in G2 (P=NS). All the secondary end points were significantly better in G2.
  
  
  CONCLUSIONS
  These results show that EVAR with standard endograft is an effective and reliable option in AAA with neck length ≤1 cm in short and mid-term follow-up. Long-term follow-up results are needed.
authors.affiliation: Vascular Surgery, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum, Bologna University, Bologna, Italy. antonio.freyrie@unibo.it
authors.forename: A
authors.initials: A
authors.lastname: Freyrie
authors.forename: M
authors.initials: M
authors.lastname: Gargiulo
authors.forename: E
authors.initials: E
authors.lastname: Gallitto
authors.forename: G L
authors.initials: GL
authors.lastname: Faggioli
authors.forename: G
authors.initials: G
authors.lastname: Testi
authors.forename: F
authors.initials: F
authors.lastname: Giovanetti
authors.forename: A
authors.initials: A
authors.lastname: Stella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome