title: Pushing forward the limits of EVAR: new therapeutic solutions for extremely challenging AAAs using the Ovation® stent-graft.
abstract: BACKGROUND
  Extreme complex aortic anatomies still represent the major limit of endovascular aneurysms repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA). Aim of this study was to evaluate results of EVAR with Ovation® stent-graft in extremely complex aortic anatomies.
  
  
  METHODS
  A single center study was retrospectively conducted on a prospectively compiled computerized database between July 2012 and July 2014. Twenty-one elective patients with atherosclerotic AAA were included. All patients were judged unfit for or refused an open approach. In all of them, extremely complex anatomies features contraindicated EVAR by common endografts. Patients' outcomes were evaluated on the basis of anatomical features: challenging proximal aortic neck (non-cylindrical, short, severely angulated, enlarged, thrombosed) and challenging iliac artery accesses (angulated and narrowed). Technical and clinical successes were defined as the absence of intraoperative surgical conversion and aneurysm related mortality, respectively. Reintervention, morbidity and mortality rates during follow-up were also recorded.
  
  
  RESULTS
  All patients were male; mean age was 75.6±7.2 years. In 14 patients (66.7%) neck length was <10 mm, a non-cylindrical neck was present in 15 patients (71.4%) and a severe neck thrombosis was registered in 13 patients (61.9%). Only 1 patient (4.8%) had no iliac tortuosity, 9 (42.8%) patients had severe tortuosity at least on one iliac access and 7 (33.3%) on both. Technical and clinical successes were achieved in all cases. Neither death nor reinterventions were observed in the present series. At a mean follow-up of 9±5 (3-27) months, only one patient presented an iliac leg occlusion.
  
  
  CONCLUSIONS
  Our limited and preliminary experience seems to show that Ovation® stent-graft may widen the range of AAAs suitable for standard EVAR. Early results, even in patients with challenging anatomies, are encouraging but a longer follow-up is mandatory.
authors: Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Sapienza University of Rome, Policlinico Umberto I, Rome, Italy - pasqualino.sirignano@gmail.com.
authors: Pasqualino
authors: P
authors: Sirignano
authors: Laura
authors: L
authors: Capoccia
authors: Danilo
authors: D
authors: Menna
authors: Wassim
authors: W
authors: Mansour
authors: Francesco
authors: F
authors: Speziale
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; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012384:Rome; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome