Are very short necks ESAR patients safe from type 1A endoleak risk?

BACKGROUND: The aim of this study was to evaluate how different proximal aortic neck hostility factors affect outcomes of patients with abdominal aortic aneurysm (AAA) undergoing endosuture aneurysm repair (ESAR) in a real-world setting.METHODS: Our observational, retrospective, single-center study included all patients who consecutively underwent ESAR from October 2015 to October 2022 at our Institution. Patients were divided into two groups; proximal aortic necks <10 mm in length were included in group 1 "Short" and tapered, dilated, and angulated necks were aggregated into group 2 "Other." Primary study outcome was the occurrence of type 1A endoleak; secondary outcomes included overall survival, aneurysm-related death, procedure-related reintervention, procedural complications, and reduction of the residual aneurysmal sac.RESULTS: The study included 52 patients: 28 in Group 1 (Short) and 24 in Group 2 (Other). At the median 32-month follow-up, primary outcome was reported in 11 with a difference between the two groups (P<0.001). Procedure-related reintervention was reported in 6 (11.8%). ROC curve analysis identified a cutoff of 5.5mm for increased type 1A endoleak risk (HR:11).CONCLUSIONS: ESAR is a safe and effective adjunct to EVAR for complex anatomies, but a neck shorter than 5.5-mm increases type 1A endoleak risk in ESAR patients.