PURPOSE: To report a systematic review and meta-analysis of outcomes following endovascular aneurysm repair (EVAR) in patients with hostile neck anatomy (HNA) vs. those with favorable neck anatomy (FNA). METHODS: Systematic review and meta-analysis of data on EVAR in patients with HNA and FNA was performed by 2 reviewers in February 2013. An eligible study was required to have at least 50 participants and to incorporate one or more of the HNA criteria of neck length <15 mm, neck diameter >28 mm, and/or angulation >60°. Of the 24 full-length articles ultimately reviewed, 8 were excluded, resulting in 16 articles that were suitable for inclusion in the meta-analysis. The study size ranged from 55 to 5183 participants, with a total of 8920 patients in the FNA group and 3039 patients in the HNA group. Mean follow-up ranged from 9 to 49 months. RESULTS: Analysis of the pooled data revealed a significant increase in 30-day mortality (2.4% FNA vs. 3.5% HNA; OR 1.60, 95% CI 1.13 to 2.27; p<0.01), intraoperative adjuncts (8.8% FNA vs. 15.4% HNA; OR 1.88, 95% CI 1.15 to 3.07; p=0.01), and 30-day migration (0.9% FNA vs. 1.6% HNA; OR 2.08, 95% CI 1.20 to 3.62; p=0.009) in patients with HNA. A decrease in primary technical success (97.5% FNA vs. 93.8% HNA; OR 0.41, 95% CI 0.18 to 0.93; p=0.03) was significant when all 3 criteria were used to define HNA. For outcomes at >30 days, the increase in secondary interventions (OR 1.29, 95% CI 1.00 to 1.66; p=0.05) approached significance, but aneurysm-related mortality, all-cause mortality, migration, and aortic rupture did not achieve statistical significance. There was no difference in rates of sac expansion. Analysis of endoleak rates revealed a significant increase in 30-day type I endoleaks (OR 2.92, 95% CI 1.61 to 5.30; p<0.001) and late type I endoleaks (OR 1.71, 95% CI 1.31 to 2.23; p<0.0001) in patients with HNA. CONCLUSION: These results suggest that performing EVAR in patients with HNA increases the technical difficulty and results in poorer short-term outcomes. The higher rates of early and late type I endoleaks, along with secondary interventions, suggest that increased monitoring should be performed in this category of patient to ensure rapid treatment.
PURPOSE: To report a systematic review and meta-analysis of outcomes following endovascular aneurysm repair (EVAR) in patients with hostile neck anatomy (HNA) vs. those with favorable neck anatomy (FNA). METHODS: Systematic review and meta-analysis of data on EVAR in patients with HNA and FNA was performed by 2 reviewers in February 2013. An eligible study was required to have at least 50 participants and to incorporate one or more of the HNA criteria of neck length <15 mm, neck diameter >28 mm, and/or angulation >60°. Of the 24 full-length articles ultimately reviewed, 8 were excluded, resulting in 16 articles that were suitable for inclusion in the meta-analysis. The study size ranged from 55 to 5183 participants, with a total of 8920 patients in the FNA group and 3039 patients in the HNA group. Mean follow-up ranged from 9 to 49 months. RESULTS: Analysis of the pooled data revealed a significant increase in 30-day mortality (2.4% FNA vs. 3.5% HNA; OR 1.60, 95% CI 1.13 to 2.27; p<0.01), intraoperative adjuncts (8.8% FNA vs. 15.4% HNA; OR 1.88, 95% CI 1.15 to 3.07; p=0.01), and 30-day migration (0.9% FNA vs. 1.6% HNA; OR 2.08, 95% CI 1.20 to 3.62; p=0.009) in patients with HNA. A decrease in primary technical success (97.5% FNA vs. 93.8% HNA; OR 0.41, 95% CI 0.18 to 0.93; p=0.03) was significant when all 3 criteria were used to define HNA. For outcomes at >30 days, the increase in secondary interventions (OR 1.29, 95% CI 1.00 to 1.66; p=0.05) approached significance, but aneurysm-related mortality, all-cause mortality, migration, and aortic rupture did not achieve statistical significance. There was no difference in rates of sac expansion. Analysis of endoleak rates revealed a significant increase in 30-day type I endoleaks (OR 2.92, 95% CI 1.61 to 5.30; p<0.001) and late type I endoleaks (OR 1.71, 95% CI 1.31 to 2.23; p<0.0001) in patients with HNA. CONCLUSION: These results suggest that performing EVAR in patients with HNA increases the technical difficulty and results in poorer short-term outcomes. The higher rates of early and late type I endoleaks, along with secondary interventions, suggest that increased monitoring should be performed in this category of patient to ensure rapid treatment.
Authors: S L Zettervall; S E Deery; P A Soden; K Shean; J J Siracuse; M Alef; V I Patel; M L Schermerhorn Journal: Eur J Vasc Endovasc Surg Date: 2017-08-02 Impact factor: 7.069
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: S L Zettervall; P A Soden; S E Deery; K Ultee; K E Shean; F Shuja; R L Amdur; M L Schermerhorn Journal: Eur J Vasc Endovasc Surg Date: 2017-03-06 Impact factor: 7.069
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: Salvatore T Scali; Adam W Beck; Catherine K Chang; Dan Neal; Robert J Feezor; David H Stone; Scott A Berceli; Thomas S Huber Journal: J Vasc Surg Date: 2015-11-21 Impact factor: 4.268
Authors: Salvatore T Scali; Sara J Runge; Robert J Feezor; Kristina A Giles; Javairiah Fatima; Scott A Berceli; Thomas S Huber; Adam W Beck Journal: J Vasc Surg Date: 2016-06-07 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
Authors: Tomasz Synowiec; Marcin Warot; Paweł Burchardt; Paweł Chęciński Journal: Wideochir Inne Tech Maloinwazyjne Date: 2015-07-07 Impact factor: 1.195