The AAA With a Challenging Neck: Outcome of Open Versus Endovascular Repair With Standard and Fenestrated Stent-Grafts
(2009) In Journal of Endovascular Therapy 16(2). p.137-146- Abstract
- Purpose: To compare the outcome of endovascular aneurysm repair (EVAR) versus conventional open repair (OR) in patients with a short, angulated or otherwise challenging proximal neck. Methods: The definition of a challenging proximal neck was based on diameter (>= 28 mm), length (<= 115 mm), angulation (>= 60 degrees), shape (reverse tapered or bulging), and thrombus lining (>50%). Between January 2005 and December 2007, 187 consecutive patients (159 men; mean age 73 years, range 48-92) operated for asymptomatic abdominal aortic aneurysm (AAA) were identified as having challenging proximal neck morphology. Of these, 61 patients were treated with OR at center I (group A), 71 with standard EVAR (group B; 45 center I, 29 center... (More)
- Purpose: To compare the outcome of endovascular aneurysm repair (EVAR) versus conventional open repair (OR) in patients with a short, angulated or otherwise challenging proximal neck. Methods: The definition of a challenging proximal neck was based on diameter (>= 28 mm), length (<= 115 mm), angulation (>= 60 degrees), shape (reverse tapered or bulging), and thrombus lining (>50%). Between January 2005 and December 2007, 187 consecutive patients (159 men; mean age 73 years, range 48-92) operated for asymptomatic abdominal aortic aneurysm (AAA) were identified as having challenging proximal neck morphology. Of these, 61 patients were treated with OR at center I (group A), 71 with standard EVAR (group B; 45 center I, 29 center II) and 52 with fenestrated EVAR (group C) at center II. Clinical examination and computed tomography were performed at 1 month and yearly thereafter. Results: There was no statistically significant difference between groups A, B, and C regarding primary technical success rate, 30-day mortality, or late AAA-related mortality. The mean length of follow-up was 19.5 months (range 0-40). Freedom from reintervention at 3 years was 91.8%, 79.7%, and 82.7% for groups A, B, and C, respectively (p=0.042). The only statistically significant difference between standard and fenestrated EVAR was a higher incidence of late sac expansion [9 (12.2%) versus 1 (1.9%), p=0.036] in the standard stent-graft group. Reinterventions were more frequent after EVAR (p=NS), but open reinterventions were more common after OR. Reinterventions after EVAR were related to the presence of an angulated (p=0.039) or short neck (p=0.024). Conclusion:The results of EVAR and OR were similar for AAAs with a challenging proximal neck. Endovascular reinterventions were more frequent after EVAR, particularly in patients with an angulated or short neck. Open reinterventions were more common after OR. More patients and long-term data are needed to confirm these findings. J Endovasc Ther. 2009;16:137-146 (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1443588
- author
- Chisci, Emiliano ; Kristmundsson, Thorarinn ; de Donato, Gianmarco ; Resch, Timothy ; Setacci, Francesco ; Sonesson, Björn LU ; Setacci, Carlo and Malina, Martin LU
- organization
- publishing date
- 2009
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- abdominal aortic aneurysm, endovascular aneurysm repair, stent-graft, proximal neck, surgery, fenestrated stent-graft
- in
- Journal of Endovascular Therapy
- volume
- 16
- issue
- 2
- pages
- 137 - 146
- publisher
- International Society of Endovascular Specialists
- external identifiers
-
- wos:000266567700003
- scopus:67249153450
- ISSN
- 1545-1550
- DOI
- 10.1583/08-2531.1
- language
- English
- LU publication?
- yes
- additional info
- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Emergency medicine/Medicine/Surgery (013240200)
- id
- 0401f1c3-17dd-4010-a315-8593de495545 (old id 1443588)
- date added to LUP
- 2016-04-01 12:27:24
- date last changed
- 2022-04-13 19:17:11
@article{0401f1c3-17dd-4010-a315-8593de495545, abstract = {{Purpose: To compare the outcome of endovascular aneurysm repair (EVAR) versus conventional open repair (OR) in patients with a short, angulated or otherwise challenging proximal neck. Methods: The definition of a challenging proximal neck was based on diameter (>= 28 mm), length (<= 115 mm), angulation (>= 60 degrees), shape (reverse tapered or bulging), and thrombus lining (>50%). Between January 2005 and December 2007, 187 consecutive patients (159 men; mean age 73 years, range 48-92) operated for asymptomatic abdominal aortic aneurysm (AAA) were identified as having challenging proximal neck morphology. Of these, 61 patients were treated with OR at center I (group A), 71 with standard EVAR (group B; 45 center I, 29 center II) and 52 with fenestrated EVAR (group C) at center II. Clinical examination and computed tomography were performed at 1 month and yearly thereafter. Results: There was no statistically significant difference between groups A, B, and C regarding primary technical success rate, 30-day mortality, or late AAA-related mortality. The mean length of follow-up was 19.5 months (range 0-40). Freedom from reintervention at 3 years was 91.8%, 79.7%, and 82.7% for groups A, B, and C, respectively (p=0.042). The only statistically significant difference between standard and fenestrated EVAR was a higher incidence of late sac expansion [9 (12.2%) versus 1 (1.9%), p=0.036] in the standard stent-graft group. Reinterventions were more frequent after EVAR (p=NS), but open reinterventions were more common after OR. Reinterventions after EVAR were related to the presence of an angulated (p=0.039) or short neck (p=0.024). Conclusion:The results of EVAR and OR were similar for AAAs with a challenging proximal neck. Endovascular reinterventions were more frequent after EVAR, particularly in patients with an angulated or short neck. Open reinterventions were more common after OR. More patients and long-term data are needed to confirm these findings. J Endovasc Ther. 2009;16:137-146}}, author = {{Chisci, Emiliano and Kristmundsson, Thorarinn and de Donato, Gianmarco and Resch, Timothy and Setacci, Francesco and Sonesson, Björn and Setacci, Carlo and Malina, Martin}}, issn = {{1545-1550}}, keywords = {{abdominal aortic aneurysm; endovascular aneurysm repair; stent-graft; proximal neck; surgery; fenestrated stent-graft}}, language = {{eng}}, number = {{2}}, pages = {{137--146}}, publisher = {{International Society of Endovascular Specialists}}, series = {{Journal of Endovascular Therapy}}, title = {{The AAA With a Challenging Neck: Outcome of Open Versus Endovascular Repair With Standard and Fenestrated Stent-Grafts}}, url = {{http://dx.doi.org/10.1583/08-2531.1}}, doi = {{10.1583/08-2531.1}}, volume = {{16}}, year = {{2009}}, }