title: Remodeling of proximal neck angulation after endovascular aneurysm repair.
abstract: OBJECTIVE
  This study investigated the remodeling of proximal neck (PN) angulations of abdominal aortic aneurysms (AAAs) after endovascular aneurysm repair (EVAR).
  
  
  METHODS
  A 64-row multidetector computed tomography scan of AAAs treated with EVAR was reviewed, and the PN angulation was measured on a volume-rendered three-dimensional image. The computed tomography scan was examined preoperatively, after EVAR at 1 week, 1 month, 6 months, 1 year, 1.5 years, 2 years, and then yearly. The study enrolled 78 patients, comprising 54 Zenith devices (Cook Medical, Bloomington, Ind) and 24 Excluder devices (W. L. Gore and Associates, Flagstaff, Ariz).
  
  
  RESULTS
  PN angulation was 50° ± 20° preoperatively, and after EVAR was 36° ± 14° at 1 week, 32° ± 14° at 1 year, and 28° ± 13° at 3 years. PN angulations ≤ 60° (n = 70, 77%) were 41° ± 13° preoperatively, 31° ± 12° 1 week after EVAR, 28° ± 12° at 1 year, and 26° ± 13° after 3 years. An angulation >60° (n = 18, 23%) was 78° ± 14° preoperatively, 51° ± 11° 1 week after EVAR, 44° ± 11° at 1 year, and 40° ± 12° after 3 years. The greater the preoperative PN angulation, the greater its reduction immediately after EVAR (r = .72, P < .001). The diameter shrinkage of AAAs with a PN angulation >60° was 3 ± 6 mm after 1 year; a significantly smaller shrinkage than with a PN angulation ≤ 60° (7 ± 7 mm, P < .05). AAAs with a PN angulation >60° had a larger angulation reduction and a smaller diameter shrinkage after the EVAR procedure. The PN angulation of the 54 AAAs treated by Zenith was 49° ± 22° preoperatively, 34° ± 14° 1 week after EVAR, and 25° ± 13° after 3 years. The corresponding angulation of the 24 AAAs treated by Excluder devices was 52° ± 17°, 41° ± 14°, and 38° ± 9°, respectively. The PN angulation reduction of Zenith and Excluder was similar 1 week after the EVAR procedure. Unlike Excluder, however, the PN angulation in Zenith continued to reduce for a long period at a slow pace. There were no significant correlations between PN angulation reduction and diameter change and between PN length and diameter change (P = .86 and .18, respectively).
  
  
  CONCLUSIONS
  Although the instructions for use of most commercially available stent grafts provide for a PN angulation of ≤ 60°, PN angulation was not a major issue in a midterm follow-up of AAAs with adequate PN length for patients in this series who received a Zenith or Excluder graft.
authors: Department of Vascular Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan. ishibash@aichi-med-u.ac.jp
authors: Hiroyuki
authors: H
authors: Ishibashi
authors: Tsuneo
authors: T
authors: Ishiguchi
authors: Takashi
authors: T
authors: Ohta
authors: Ikuo
authors: I
authors: Sugimoto
authors: Tetsuya
authors: T
authors: Yamada
authors: Masao
authors: M
authors: Tadakoshi
authors: Noriyuki
authors: N
authors: Hida
authors: Yuki
authors: Y
authors: Orimoto
mesh_terms: D001012:Aorta, Abdominal / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D057510:Endovascular Procedures; D005500:Follow-Up Studies; D006801:Humans; D011859:Radiography; D013997:Time Factors