title: A Systematic Review of Proximal Neck Dilatation After Endovascular Repair for Abdominal Aortic Aneurysm.
abstract: To provide an updated systematic literature review and summarize current evidence on proximal aortic neck dilatation (AND) after endovascular aneurysm repair (EVAR).
  
  
  
  A review of the English-language medical literature from 1991 to 2015 was conducted using MEDLINE and EMBASE to identify studies reporting AND after EVAR. Studies considered for inclusion and full-text review fulfilled the following criteria: (1) reported AND after EVAR, (2) included at least 5 patients, and (3) provided data on AND quantification. The search identified 26 articles published between 1998 and 2015 that encompassed 9721 patients (median age 71.8 years; 9439 men).
  
  
  
  AND occurred in 24.6% of patients (95% CI 18.6% to 31.8%) over a period ranging from 15 months to 9 years after EVAR. No significant dilatation of the suprarenal part of the aorta was reported by most studies. The incidence of combined clinical events (endoleak type I, migration, reintervention during follow-up) was higher in the AND group (26%) when compared with 2% in the group without AND (OR 28.7, 95% CI 5.43 to 151.67, p<0.001).
  
  
  
  AND affects a considerable proportion of EVAR patients and was related to worse clinical outcome, as indicated by increased rates of type I endoleak, migration, and reinterventions. Future studies should focus on a better understanding of the pathophysiology, predictors, and risk factors of AND, which could identify patients who may warrant a different EVAR strategy and/or a closer post-EVAR surveillance strategy.
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
authors.forename: George N
authors.initials: GN
authors.lastname: Kouvelos
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Oikonomou
authors.affiliation: 2 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
authors.forename: Eric L G
authors.initials: EL
authors.lastname: Verhoeven
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Katsargyris
mesh_terms: D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D004108:Dilatation, Pathologic; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016017:Odds Ratio; D019233:Retreatment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic neck dilatation; endoleak; endovascular aneurysm repair; follow-up; migration; reintervention; surveillance; systematic review