title: Results of the Anaconda endovascular graft in abdominal aortic aneurysm with a severe angulated infrarenal neck.
abstract: OBJECTIVE
  Proximal neck anatomy of an abdominal aortic aneurysm (AAA), especially a severe angulated neck of more than 60 degrees, predicts adverse outcome in endovascular aneurysm repair. In the present study, we evaluate the feasibility of the use of the Anaconda endovascular graft (Vascutec, Terumo, Inchinnan, Scotland) for treating infrarenal AAA with a severe angulated neck (>60 degrees) and report the midterm outcomes.
  
  
  METHODS
  In total, nine Dutch hospitals participated in this prospective cohort study. From December 2005 to January 2011, a total of 36 AAA patients, 30 men and six women, were included. Mean and median follow-up were both 40 months.
  
  
  RESULTS
  Mean infrarenal neck angulation was 82 degrees. Successful deployment was reached in 34 of 36 patients. Primary technical success was achieved in 30 of 36 patients (83%). There was no aneurysm-related death. Four-year primary clinical success was 69%. In the first year, eight clinical failures were reported including four leg occlusions which could be solved using standard procedures. After the first year, three patients with additional failures occurred; two of them were leg occlusions. Four patients needed conversion to open AAA exclusion. In six of 36 patients, one or more reinterventions were necessary. Three of them were performed for occlusion of one Anaconda leg and two were for occlusion of the body.
  
  
  CONCLUSIONS
  The use of the Anaconda endovascular graft in AAA with a severe angulated infrarenal neck is feasible but has its side effects. Most clinical failures occur in the first year. Thereafter, few problems occur, and midterm results are acceptable. Summarizing the present experiences, we conclude that open AAA repair is still a preferable option in patients with challenging aortic neck anatomy and fit for open surgery.
authors: Department of Surgery, Martini Hospital, Groningen, The Netherlands; Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands.
authors: Steffan G J
authors: SG
authors: Rödel
authors: Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Clark J
authors: CJ
authors: Zeebregts
authors: Division of Interventional Radiology, Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands.
authors: Ad B
authors: AB
authors: Huisman
authors: Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands. Electronic address: r.geelkerken@mst.nl.
authors: Robert H
authors: RH
authors: Geelkerken
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D011474:Prosthesis Design; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome