title: Mid-Term Results of EVAR in Severe Proximal Aneurysm Neck Angulation.
abstract: OBJECTIVE
  To determine if mid-term outcome following endovascular aneurysm repair (EVAR) with the Endurant Stent Graft (Medtronic, Santa Rosa, CA, USA) is influenced by severe proximal neck angulation.
  
  
  METHODS
  A retrospective case-control study was performed using data from a prospective multicenter database. All measurements were obtained using dedicated reconstruction software and center-lumen line reconstruction. Patients with neck length >15 mm, infrarenal angle β > 75°, and/or suprarenal angle α > 60°, or neck length >10 mm with β > 60°, and/or α > 45° were compared with a matched control group. Primary endpoint was primary clinical success. Secondary endpoints were freedom from rupture, type 1A endoleak, stent fractures, freedom from neck-related reinterventions, and aneurysm-related adverse events. Morphological neck variation over time was also assessed.
  
  
  RESULTS
  Forty-five patients were included in the study group and were compared with a matched control group with 65 patients. Median follow-up time was 49.5 months (range 30.5-58.4). The 4-year primary clinical success estimates were 83% and 80% for the angulated and nonangulated groups (p = .42). Proximal neck angulation did not affect primary clinical success in a multivariate model (hazard ratio 1.56, 95% confidence interval 0.55-4.41).Groups did not differ significantly in regard to freedom from rupture (p =.79), freedom from type 1A endoleak (p = .79), freedom from neck-related adverse events (p = .68), and neck-related reinterventions (p = .68). Neck angle reduction was more pronounced in patients with severe proximal neck angulation (mean deltaα -15.6°, mean deltaβ -30.6°) than in the control group (mean deltaα -0.39°, mean deltaβ -5.9°) (p < .001).
  
  
  CONCLUSIONS
  Mid-term outcomes following EVAR with the Endurant Stent Graft were not influenced by severe proximal neck angulation in our population. Despite the conformability of the device, moderate aortic neck remodeling was identified in the group of patients with angulated neck anatomy on the first computed tomography scan after implantation with no important further remodeling afterwards. No device integrity failures were encountered.
authors.forename: N F G
authors.initials: NF
authors.lastname: Oliveira
authors.forename: F M
authors.initials: FM
authors.lastname: Bastos Gonçalves
authors.forename: J-P P M
authors.initials: JP
authors.lastname: de Vries
authors.forename: K H J
authors.initials: KH
authors.lastname: Ultee
authors.forename: D A B
authors.initials: DA
authors.lastname: Werson
authors.forename: S E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: F
authors.initials: F
authors.lastname: Moll
authors.forename: J A
authors.initials: JA
authors.lastname: van Herwaarden
authors.forename: H J M
authors.initials: HJ
authors.lastname: Verhagen
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D001019:Aortic Rupture / Q000453:epidemiology; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016022:Case-Control Studies; D057867:Endoleak / Q000453:epidemiology; D057510:Endovascular Procedures / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome