title: Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck.
abstract: OBJECTIVE
  The purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.
  
  
  METHODS
  A retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.
  
  
  RESULTS
  The median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93%, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).
  
  
  CONCLUSIONS
  EVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.
authors.affiliation: Department of Vascular Surgery, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, 1st Floor North Wing, London, SE1 7EH, UK, prakash.2.saha@kcl.ac.uk.
authors.forename: Prakash
authors.initials: P
authors.lastname: Saha
authors.forename: John
authors.initials: J
authors.lastname: Hughes
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Patel
authors.forename: Tommaso
authors.initials: T
authors.lastname: Donati
authors.forename: Morad
authors.initials: M
authors.lastname: Sallam
authors.forename: Sanjay D
authors.initials: SD
authors.lastname: Patel
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Bell
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Katsanos
authors.forename: Bijan
authors.initials: B
authors.lastname: Modarai
authors.forename: Hany A
authors.initials: HA
authors.lastname: Zayed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D057867:Endoleak / Q000453:epidemiology; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome