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The AAA With a Challenging Neck: Outcome of Open Versus Endovascular Repair With Standard and Fenestrated Stent-Grafts

Chisci, Emiliano; Kristmundsson, Thorarinn; de Donato, Gianmarco; Resch, Timothy; Setacci, Francesco; Sonesson, Björn LU ; Setacci, Carlo and Malina, Martin LU (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)
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author
organization
publishing date
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
id
0401f1c3-17dd-4010-a315-8593de495545 (old id 1443588)
date added to LUP
2009-07-17 12:29:55
date last changed
2017-10-29 03:41:45
@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 (&gt;= 28 mm), length (&lt;= 115 mm), angulation (&gt;= 60 degrees), shape (reverse tapered or bulging), and thrombus lining (&gt;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},
  keyword      = {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},
  volume       = {16},
  year         = {2009},
}