title: Outcomes and morphologic changes after endovascular repair for abdominal aortic aneurysms with a severely angulated neck- a device-specific analysis.
abstract: BACKGROUND
  With respect to endovascular aneurysm repair (EVAR), the development of advanced techniques and devices, namely, Cook Zenith and Gore Excluder, has helped overcome device-related problems, including device migration. Deformities of abdominal aortic aneurysms (AAAs) can influence the long-term outcome of EVAR. The post-implantation behavior of stent grafts in AAAs with a severely angulated neck (SAN) was examined.
  
  
  RESULTS
  Among 190 AAA patients who underwent EVAR, 46 had SAN of more than 60 degrees. The post-implantation angle and adverse events were evaluated. Forty-one patients (89%) showed straightening of the neck angle immediately after the operation (early), with 2 types of subsequent (late) configuration changes - recoil and additional straightening. Among 34 Excluder patients, 29 showed immediate straightening, without additional straightening and 8 exhibited recoil. All 12 Zenith patients showed immediate straightening; 7 subsequently exhibited additional straightening, and none of them showed recoil. A difference (P=0.04) was noted between the 2 devices in the late angle changes. In all cases, no migration was observed at the proximal sites.
  
  
  CONCLUSIONS
  The post-implantation configuration changes in stent placement in AAA patients with SAN were different for Excluder and Zenith. Appropriate device selection and proper planning of the procedure is necessary for EVAR.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. traruba@gmail.com
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Hoshina
authors.forename: Takafumi
authors.initials: T
authors.lastname: Akai
authors.forename: Toshio
authors.initials: T
authors.lastname: Takayama
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kato
authors.forename: Tatsu
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okamoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shigematsu
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000473:pathology* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology* / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents