Severe infrarenal aortic neck angulation was associated with a higher risk of short-term proximal type I endoleak (OR 2.32; 95% CI 1.60-3.37; p<0.0001) after endovascular AAA repair.
Cohort (n=5,183)
Yes
Does severe infrarenal neck angulation increase the risk of complications following endovascular abdominal aortic aneurysm repair?
Severe infrarenal aortic neck angulation (>60 degrees) is associated with an increased risk of proximal type I endoleak and proximal neck dilatation following endovascular AAA repair.
Odds Ratio: 2.32 (95% CI 1.6–3.37)
p-value: p=<0.0001
PURPOSE: To examine the influence of severe infrarenal neck angulation (SNA) on complications after endovascular repair of abdominal aortic aneurysm (AAA). METHODS: From October 1996 to January 2006, 5183 patients who underwent endovascular aneurysm repair using a Talent, Zenith, or Excluder stent-graft were enrolled into the EUROSTAR registry. Incidence of proximal type I endoleak, stent-graft migration, proximal neck dilatation, aneurysm rupture, secondary interventions, and all-cause and aneurysm-related mortality were compared between patients with and without severe infrarenal neck angulation (>60 degrees angle between the infrarenal aortic neck and the longitudinal axis of the aneurysm). RESULTS: In the short term (before discharge), proximal type I endoleak (OR 2.32, 95% CI 1.60 to 3.37, p or =4 mm (HR 1.26, 95% CI 1.11 to 1.43, p=0.0004), proximal type I endoleak (HR 1.80, 95% CI 1.25 to 2.58, p=0.0016), and need for secondary interventions (HR 1.29, 95% CI 1.00 to 1.67, p=0.0488) were seen in patients with SNA. All-cause mortality, aneurysm-related mortality, and rupture of the aneurysm were similar in patients with and without severe neck angulation. In the subgroup of patients with an Excluder endograft, proximal endoleak at the completion angiogram (OR 4.49, 95% CI 1.31 to 15.32, p=0.0166) and long-term proximal neck dilatation (HR 1.67, 95% CI 1.20 to 2.33, p=0.0026) were more frequently observed in patients with SNA. In the Zenith subgroup, proximal endoleak at the completion angiogram (OR 2.62, 95% CI 1.49 to 4.63, p=0.0009) and proximal stent-graft migration before discharge (OR 2.34, 95% CI 1.06 to 5.19, p=0.0353) were more common in patients with SNA. In the Talent subgroup, long-term proximal endoleak (HR 2.09, 95% CI 1.27 to 3.44, p=0.0036), proximal neck dilatation (HR 1.29, 95% CI 1.05 to 1.60, p=0.0168), and secondary interventions (HR 1.54, 95% CI 1.05 to 2.24, p=0.0259) were more frequently observed in patients with SNA. CONCLUSION: Severe infrarenal aortic neck angulation was clearly associated with proximal type I endoleak, while the relationship with stent-graft migration was not clear. Excluder, Zenith, and Talent stent-grafts perform well in patients with severe neck angulation, with only a few differences among devices.
Hobo et al. (2007) conducted a cohort in Abdominal aortic aneurysm (AAA) (n=5,183). Severe infrarenal neck angulation (>60 degrees) vs. Without severe infrarenal neck angulation was evaluated on Short-term proximal type I endoleak (OR 2.32, 95% CI 1.60-3.37, p=<0.0001). Severe infrarenal aortic neck angulation was associated with a higher risk of short-term proximal type I endoleak (OR 2.32; 95% CI 1.60-3.37; p<0.0001) after endovascular AAA repair.