Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Influence of Unfavorable Aortoiliac Anatomy on Short-Term Outcomes after Endovascular Aortic Repair

  • Lee, Jae Hang (Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital) ;
  • Choi, Jin-Ho (Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital) ;
  • Kim, Eung-Joong (Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital)
  • Received : 2018.01.23
  • Accepted : 2018.03.22
  • Published : 2018.06.05
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Abstract

Background: Endovascular aortic repair (EVAR) is widely performed to treat infrarenal abdominal aortic aneurysms (AAAs), and related techniques and devices continue to be developed. Although continuous attempts have been made to perform EVAR in patients with unfavorable aortic anatomy, the outcomes are still controversial. This study examined the short-term outcomes of EVAR for the treatment of infrarenal AAAs in patients with a 'hostile' neck and unfavorable iliac anatomy. Methods: Thirty-eight patients who underwent EVAR from January 2012 to December 2017 were enrolled in this study. A hostile neck was defined based on neck length, angulation, the presence of an associated thrombus, or a conical shape. Unfavorable iliac anatomy was considered to be present in patients with a short common iliac artery (<15 mm) or the presence of aneurysmal changes. Results: No perioperative mortality was recorded. No significant differences were found depending on the presence of a hostile neck, but aneurysmal sac shrinkage was significantly less common in the group with unfavorable iliac anatomy (p=0.04). A multivariate analysis performed to analyze the risk factors for aneurysmal progression revealed only unfavorable iliac anatomy to be a risk factor (p=0.02). Conclusion: Patients with unfavorable aortic anatomy showed relatively satisfactory short-term outcomes after EVAR. No difference in the surgical outcomes was observed in patients with a hostile neck. However, unfavorable iliac anatomy was found to inhibit the shrinkage of the aneurysmal sac.

Keywords

References

  1. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004;364:843-8. https://doi.org/10.1016/S0140-6736(04)16979-1
  2. Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004;351:1607-18. https://doi.org/10.1056/NEJMoa042002
  3. Lederle FA, Freischlag JA, Kyriakides TC, et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med 2012;367:1988-97. https://doi.org/10.1056/NEJMoa1207481
  4. De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010;362:1881-9. https://doi.org/10.1056/NEJMoa0909499
  5. Stather PW, Sayers RD, Cheah A, Wild JB, Bown MJ, Choke E. Outcomes of endovascular aneurysm repair in patients with hostile neck anatomy. Eur J Vasc Endovasc Surg 2012;44:556-61. https://doi.org/10.1016/j.ejvs.2012.10.003
  6. Mastracci TM, Eagleton MJ, Kuramochi Y, Bathurst S, Wolski K. Twelve-year results of fenestrated endografts for juxtarenal and group IV thoracoabdominal aneurysms. J Vasc Surg 2015;61:355-64. https://doi.org/10.1016/j.jvs.2014.09.068
  7. Perdikides T, Melas N, Lagios K, et al. Primary endoanchoring in the endovascular repair of abdominal aortic aneurysms with an unfavorable neck. J Endovasc Ther 2012;19:707-15. https://doi.org/10.1583/JEVT-12-4008R.1
  8. Farahmand P, Becquemin JP, Desgranges P, Allaire E, Marzelle J, Roudot-Thoraval F. Is hypogastric artery embolization during endovascular aortoiliac aneurysm repair (EVAR) innocuous and useful? Eur J Vasc Endovasc Surg 2008;35:429-35. https://doi.org/10.1016/j.ejvs.2007.12.001
  9. Karch LA, Hodgson KJ, Mattos MA, Bohannon WT, Ramsey DE, McLafferty RB. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2000;32:676-83. https://doi.org/10.1067/mva.2000.109750
  10. Verzini F, Parlani G, Romano L, De Rango P, Panuccio G, Cao P. Endovascular treatment of iliac aneurysm: concurrent comparison of side branch endograft versus hypogastric exclusion. J Vasc Surg 2009;49:1154-61. https://doi.org/10.1016/j.jvs.2008.11.100
  11. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491-9. https://doi.org/10.1007/BF02015271
  12. Sternbergh WC 3rd, Carter G, York JW, Yoselevitz M, Money SR. Aortic neck angulation predicts adverse outcome with endovascular abdominal aortic aneurysm repair. J Vasc Surg 2002;35:482-6. https://doi.org/10.1067/mva.2002.119506
  13. Schanzer A, Greenberg RK, Hevelone N, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 2011;123:2848-55. https://doi.org/10.1161/CIRCULATIONAHA.110.014902
  14. Antoniou GA, Schiro A, Antoniou SA, et al. Chimney technique in the endovascular management of complex aortic disease. Vascular 2012;20:251-61. https://doi.org/10.1258/vasc.2011.ra0056
  15. Moulakakis KG, Mylonas SN, Avgerinos E, et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg 2012;55:1497-503. https://doi.org/10.1016/j.jvs.2011.10.009
  16. Tambyraja AL, Fishwick NG, Bown MJ, Nasim A, McCarthy MJ, Sayers RD. Fenestrated aortic endografts for juxtarenal aortic aneurysm: medium term outcomes. Eur J Vasc Endovasc Surg 2011;42:54-8. https://doi.org/10.1016/j.ejvs.2011.03.033
  17. Armon MP, Wenham PW, Whitaker SC, Gregson RH, Hopkinson BR. Common iliac artery aneurysms in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 1998;15:255-7. https://doi.org/10.1016/S1078-5884(98)80186-X
  18. DeRubertis BG, Quinones-Baldrich WJ, Greenberg JI, Jimenez JC, Lee JT. Results of a double-barrel technique with commercially available devices for hypogastric preservation during aortoilac endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012;56:1252-60. https://doi.org/10.1016/j.jvs.2012.04.070
  19. Hobo R, Buth J; EUROSTAR collaborators. Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts: a EUROSTAR report. J Vasc Surg 2006;43:896-902. https://doi.org/10.1016/j.jvs.2006.01.010
  20. El Batti S, Cochennec F, Roudot-Thoraval F, Becquemin JP. Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg 2013;57:1291-7. https://doi.org/10.1016/j.jvs.2012.10.118

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