Endovascular management of infrarenal aortic aneurysm with hostile neck, comparative study

Abstract

Objective: is to compare results of endovascular management in patients with hostile and favorable neck infrarenal abdominal aortic aneurysms.Methods: We conducted a non randomized control study assigning patients with infrarenal abdominal aortic aneurysm (AAA) treated with commercially available endoprosthesis from January 2019 through January 2020 over one year follow up. Two groups were studied, favorable neck group (FNG, n=17) and hostile neck group (HNG, n=18). The hostile neck anatomy was defined as, neck length of <15 mm, infrarenal angle of >60°, neck diameter of >28 mm, more than 50% circumferential thrombus, more than 50% calcified neck, and/or reverse taper neck. Endpoints include technical and assisted technical success, early and late primary outcomes (Endoleak, stent graft patency, aortic sac expansion, conversion to open repair, stent graft migration, aneurysm rupture, secondary interventions, and aneurysm-related mortality), and secondary outcomes (operative blood loss, fluoroscopy time, volume of contrast used, and hospital stay).All outcome measures were calculated using SPSS version 21.0 (SPSS IBM).Results: The difference in the primary (FNG=100%, HNG=83%) and assisted primary success, between both groups of patients was statistically insignificant (p=0.229).We had non-significant statistical difference between both groups in the incidence of systemic and local complications. There was no graft related mortality in both groups; also no patient experienced graft migration, endoleak, sac expansion, surgical conversion or wound complications within 30 days, however Complete thrombotic iliac limb occlusion occurred in one patient (5.6%) of HNG (P=1.0). One patient (5.6%) in the HNG experienced graft migration and sac expansion because of type ΙA endoleak. The patient passed away leading to 5.6% incidence of late graft related mortality (p=1.0). there was significant increase of hospital stay and the volume of contrast used in the HNG (p = 0.019 and 0.01, respectively). The difference in technical success between the FNG and the outside the IFU patients was statistically significant (P=0.024, OR 4.4, 95% CI 2.03-9.5).Conclusion: EVAR in patients with hostile neck is feasible and effective with an acceptable rate of complications and increased technical difficulty.