EVAR in patients with hostile aortic neck anatomy achieved comparable 48-month overall survival to standard anatomy (86.6% vs 88.4%, P>0.05), despite higher intraoperative type Ia endoleak rates.
Cohort (n=326)
Yes
Does EVAR in hostile aortic neck anatomy achieve comparable outcomes to standard aortic neck anatomy in patients undergoing endovascular aneurysm repair?
EVAR in patients with hostile aortic neck anatomy achieves comparable long-term clinical outcomes to those with standard anatomy, and a novel 6-point risk score can accurately predict intraoperative type Ia endoleak.
Absolute Event Rate: 86.6% vs 88.4%
p-value: p=>0.05
Objective: This study aimed to assess whether patients with hostile aortic neck (HAN) anatomy achieve comparable outcomes to those with standard aortic neck (SAN) following endovascular aneurysm repair (EVAR). Additionally, developed and externally validated an anatomical risk score model based on the entire cohort to guide access-prepared neck embolization for intraoperative type Ia endoleak (IaEL). Methods: A multicenter retrospective cohort study was conducted in two phases. Phase I compared baseline characteristics, intraoperative endoleaks, and strategies, as well as technical and clinical success between groups. Phase II identified independent anatomical predictors using multivariate logistic regression and developed a score model to facilitate intraoperative IaEL risk stratification for preoperative planning. Results: A total of 326 patients were included. The overall technical success rate was 98.2%, with no significant difference between groups ( P = 1.000). HAN cases had longer procedure times (85.0 vs. 71.0 min; P 0.05). Intraoperative IaEL occurred more often in HAN (37.1% vs 2.5%, P < 0.001). Neck length, infrarenal angulation, and conical neck were assigned weighted points to construct a six-point scoring system for intraoperative IaEL. The score model demonstrated robust discrimination (AUC = 0.853 in training and 0.842 in validation) and may serve as a tool for intraoperative risk stratification and procedural planning. Conclusions: EVAR in HAN patients can achieve outcomes comparable to those in SAN patients when intraoperative procedures are performed. The risk score offers a practical tool for preoperative risk stratification and anatomy-based procedural planning.
Wei et al. (Wed,) conducted a cohort in Aortic aneurysm requiring EVAR (n=326). EVAR in hostile aortic neck (HAN) vs. EVAR in standard aortic neck (SAN) was evaluated on Overall survival at 48 months (p=>0.05). EVAR in patients with hostile aortic neck anatomy achieved comparable 48-month overall survival to standard anatomy (86.6% vs 88.4%, P>0.05), despite higher intraoperative type Ia endoleak rates.