P W Stather1, R D Sayers, A Cheah, J B Wild, M J Bown, E Choke. 1. Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK. philstather@doctors.org.uk
Abstract
OBJECTIVES: This study aims to evaluate outcomes following EVAR in patients with hostile neck anatomy (HNA). METHODS: Data prospectively collected from 552 elective EVARs were analysed retrospectively. Data regarding neck morphology was obtained from aneurysm stent plans produced prior to EVAR. HNA was defined as any of; neck diameter >28 mm, neck angulation >60°, neck length <15 mm, neck thrombus, or neck flare. RESULTS: 552 patients underwent EVAR. Mean age 73.9 years, mean follow-up 4.1 years. 199 patients had HNA, 353 had favourable neck anatomy (FNA). There was a significant increase in late type I endoleaks (FNA 4.5%, HNA 9.5%; P = 0.02) and total reinterventions (FNA 11.0%, HNA 22.8%; P < 0.01), and a significant decrease in late type II endoleaks in patients with HNA (FNA 16.7%, HNA 10.6%; P < 0.05). There was no significant difference in technical success (FNA 0.6%, HNA 2.0%; p = 0.12), 30-day re-intervention (FNA 2.8%, HNA 5.0%; P = 0.12), 30-day mortality (FNA 1.1%, HNA 0.5%; P = 0.45), 30-day type I endoleaks (FNA 0.8%, HNA 2.5%; P = 0.12), 5-year mortality (FNA 15.1%, HNA 14.6%; P = 0.86), aneurysm-related mortality (FNA 1.7% versus HNA 2.0%; P = 0.79), stent-graft migration (FNA 2.5%, HNA 3.0%; P = 0.75), sac expansion (FNA 13.0%, HNA 9.5%; P = 0.22), or graft rupture (FNA 1.1%, HNA 3.5%; P = 0.05). Binary logistic regression of individual features of HNA revealed secondary intervention (P = 0.009), technical failure (P = 0.02), and late type I endoleaks (P = 0.002), were significantly increased with increased neck diameter. CONCLUSIONS: HNA AAAs can be successfully treated with EVAR. However, surveillance is necessary to detect and treat late type I endoleaks in HNA patients.
OBJECTIVES: This study aims to evaluate outcomes following EVAR in patients with hostile neck anatomy (HNA). METHODS: Data prospectively collected from 552 elective EVARs were analysed retrospectively. Data regarding neck morphology was obtained from aneurysm stent plans produced prior to EVAR. HNA was defined as any of; neck diameter >28 mm, neck angulation >60°, neck length <15 mm, neck thrombus, or neck flare. RESULTS: 552 patients underwent EVAR. Mean age 73.9 years, mean follow-up 4.1 years. 199 patients had HNA, 353 had favourable neck anatomy (FNA). There was a significant increase in late type I endoleaks (FNA 4.5%, HNA 9.5%; P = 0.02) and total reinterventions (FNA 11.0%, HNA 22.8%; P < 0.01), and a significant decrease in late type II endoleaks in patients with HNA (FNA 16.7%, HNA 10.6%; P < 0.05). There was no significant difference in technical success (FNA 0.6%, HNA 2.0%; p = 0.12), 30-day re-intervention (FNA 2.8%, HNA 5.0%; P = 0.12), 30-day mortality (FNA 1.1%, HNA 0.5%; P = 0.45), 30-day type I endoleaks (FNA 0.8%, HNA 2.5%; P = 0.12), 5-year mortality (FNA 15.1%, HNA 14.6%; P = 0.86), aneurysm-related mortality (FNA 1.7% versus HNA 2.0%; P = 0.79), stent-graft migration (FNA 2.5%, HNA 3.0%; P = 0.75), sac expansion (FNA 13.0%, HNA 9.5%; P = 0.22), or graft rupture (FNA 1.1%, HNA 3.5%; P = 0.05). Binary logistic regression of individual features of HNA revealed secondary intervention (P = 0.009), technical failure (P = 0.02), and late type I endoleaks (P = 0.002), were significantly increased with increased neck diameter. CONCLUSIONS: HNA AAAs can be successfully treated with EVAR. However, surveillance is necessary to detect and treat late type I endoleaks in HNA patients.
Authors: Ali F AbuRahma; Michael Yacoub; Albeir Y Mousa; Shadi Abu-Halimah; Stephen M Hass; Jenna Kazil; Zachary T AbuRahma; Mohit Srivastava; L Scott Dean; Patrick A Stone Journal: J Am Coll Surg Date: 2016-01-13 Impact factor: 6.113
Authors: Athanasios Saratzis; Michael F Bath; Seamus Harrison; Robert D Sayers; Asif Mahmood; Pantelis Sarafidis; Matthew J Bown Journal: Clin J Am Soc Nephrol Date: 2015-10-20 Impact factor: 8.237
Authors: Ali F AbuRahma; Trevor DerDerian; Zachary T AbuRahma; Stephen M Hass; Michael Yacoub; L Scott Dean; Shadi Abu-Halimah; Albeir Y Mousa Journal: J Vasc Surg Date: 2018-05-22 Impact factor: 4.268
Authors: Alan Karthikesalingam; Omneya Attallah; Xianghong Ma; Sandeep Singh Bahia; Luke Thompson; Alberto Vidal-Diez; Edward C Choke; Matt J Bown; Robert D Sayers; Matt M Thompson; Peter J Holt Journal: PLoS One Date: 2015-07-15 Impact factor: 3.240