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Evaluation of Aneurysm Neck Angle Change After Endovascular Aneurysm Repair Clinical Investigations

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Abstract

Purpose

To evaluate the aneurysm neck angle changes and post-endovascular aneurysm repair (EVAR) complications.

Methods

We retrospectively analyzed 72 cases of elective EVAR for abdominal aortic aneurysm among 109 consecutive cases from December 2005 to April 2014. Patients were divided into angulated and non-angulated groups. The angulated group was defined as neck angulation ≥60°. Neck angle was evaluated pre- and post-EVAR during short- (within 1 month), mid- (3–6 months), and long-term (>1 year) follow-up. Aneurysm sac diameter change, aneurysm neck morphology other than angulation, endoleaks, and other post-procedural complications were also documented.

Results

A total of 34 patients were enrolled in the angulated group. There were no statistical differences in age, sex, follow-up duration, and aneurysm neck profile between the two groups (p > 0.05). Both groups showed statistically significant and consistent decreases in angulation during the follow-up period (p < 0.01). The angulated group revealed 22.45 % more straightening than the non-angulated group. Recoil of the Endurant device occurred in the angulated group. No statistically significant intergroup differences were observed in any endoleaks, complications, or re-intervention rates (p > 0.05). Pre-EVAR angle was the only predictor for post-procedural angle change (p < 0.001).

Conclusion

EVAR is applicable for patients with highly angulated aneurysm neck and provides consistent neck straightening over long-term follow-up. Recoil was evident in the angulated group using the Endurant device.

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References

  1. Stather PW, Sidloff DA, Rhema IA, Choke E, Bown MJ, Sayers RD. A review of current reporting of abdominal aortic aneurysm mortality and prevalence in the literature. Eur J Vasc Endovasc Surg. 2014;47(3):240–2.

    Article  CAS  PubMed  Google Scholar 

  2. Walker TG, Kalva SP, Yeddula K, et al. Clinical practice guidelines for endovascular abdominal aortic aneurysm repair: written by the Standards of Practice Committee for the Society of Interventional Radiology and endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol: JVIR. 2010;21(11):1632–55.

    Article  PubMed  Google Scholar 

  3. Aburahma AF, Campbell JE, Mousa AY, et al. Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J Vasc Surg. 2011;54(1):13–21.

    Article  PubMed  Google Scholar 

  4. 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(6):556–61.

    Article  CAS  PubMed  Google Scholar 

  5. Hobo R, Kievit J, Leurs LJ, Buth J. Influence of severe infrarenal aortic neck angulation on complications at the proximal neck following endovascular AAA repair: a EUROSTAR study. J Endovasc Ther. 2007;14(1):1–11.

    Article  PubMed  Google Scholar 

  6. Hoshina K, Akai T, Takayama T, et al. Outcomes and morphologic changes after endovascular repair for abdominal aortic aneurysms with a severely angulated neck. Circ J. 2013;77(8):1996–2002.

    Article  PubMed  Google Scholar 

  7. Hoshina K, Hashimoto T, Kato M, Ohkubo N, Shigematsu K, Miyata T. Feasibility of endovascular abdominal aortic aneurysm repair outside of the instructions for use and morphological changes at 3 years after the procedure. Ann Vasc Dis. 2014;7(1):34–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Arko FR 3rd, Murphy EH, Boyes C, et al. Current status of endovascular aneurysm repair: 20 years of learning. Semin Vasc Surg. 2012;25(3):131–5.

    Article  PubMed  Google Scholar 

  9. Antoniou GA, Georgiadis GS, Antoniou SA, Kuhan G, Murray D. A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. J Vasc Surg. 2013;57(2):527–38.

    Article  PubMed  Google Scholar 

  10. Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y. Outcomes following endovascular abdominal aortic aneurysm repair both within and outside of the instructions for use. Ann Thorac Cardiovasc Surg. 2014;20(1):61–6.

    Article  PubMed  Google Scholar 

  11. de Vries JP. The proximal neck: the remaining barrier to a complete EVAR world. Semin Vasc Surg. 2012;25(4):182–6.

    Article  PubMed  Google Scholar 

  12. van Keulen JW, Moll FL, Arts J, Vonken EJ, van Herwaarden JA. Aortic neck angulations decrease during and after endovascular aneurysm repair. J Endovasc Ther. 2010;17(5):594–8.

    Article  PubMed  Google Scholar 

  13. Lee HK, Chung SY, Kim JK, Yoo SH, Choi SJ. Changes in suprarenal and infrarenal aortic angles after endovascular aneurysm repair. Ann Surg Treat Res. 2014;87(4):197–202.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Molony DS, Kavanagh EG, Madhavan P, Walsh MT, McGloughlin TM. A computational study of the magnitude and direction of migration forces in patient-specific abdominal aortic aneurysm stent-grafts. Eur J Vasc Endovasc Surg. 2010;40(3):332–9.

    Article  CAS  PubMed  Google Scholar 

  15. Bastos Goncalves F, de Vries JP, van Keulen JW, et al. Severe proximal aneurysm neck angulation: early results using the Endurant stentgraft system. Eur J Vasc Endovasc Surg. 2011;41(2):193–200.

    Article  CAS  PubMed  Google Scholar 

  16. Matsagkas M, Kouvelos G, Peroulis M, et al. Standard endovascular treatment of abdominal aortic aneurysms in patients with very short proximal necks using the Endurant stent graft. J Vasc Surg. 2015;61(1):9–15.

    Article  PubMed  Google Scholar 

  17. Zandvoort HJ, Goncalves FB, Verhagen HJ, et al. Results of endovascular repair of infrarenal aortic aneurysms using the Endurant stent graft. J Vasc Surg. 2014;59(5):1195–202.

    Article  PubMed  Google Scholar 

  18. Setacci F, Sirignano P, de Donato G, et al. AAA with a challenging neck: early outcomes using the Endurant stent-graft system. Eur J Vasc Endovasc Surg. 2012;44(3):274–9.

    Article  CAS  PubMed  Google Scholar 

  19. Bisdas T, Weiss K, Eisenack M, Austermann M, Torsello G, Donas KP. Durability of the Endurant stent graft in patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2014;60(5):1125–31.

    Article  PubMed  Google Scholar 

  20. Stokmans RA, Teijink JA, Forbes TL, et al. Early results from the ENGAGE registry: real-world performance of the Endurant Stent Graft for endovascular AAA repair in 1262 patients. Eur J Vasc Endovasc Surg. 2012;44(4):369–75.

    Article  CAS  PubMed  Google Scholar 

  21. Torsello G, Troisi N, Donas KP, Austermann M. Evaluation of the Endurant stent graft under instructions for use vs off-label conditions for endovascular aortic aneurysm repair. J Vasc Surg. 2011;54(2):300–6.

    Article  PubMed  Google Scholar 

  22. Bastos Goncalves F, Hoeks SE, Teijink JA, et al. Risk factors for proximal neck complications after endovascular aneurysm repair using the endurant stent graft. Eur J Vasc Endovasc Surg. 2015;49(2):156–62.

    Article  CAS  PubMed  Google Scholar 

  23. Ishibashi H, Ishiguchi T, Ohta T, et al. Remodeling of proximal neck angulation after endovascular aneurysm repair. J Vasc Surg. 2012;56(5):1201–5.

    Article  PubMed  Google Scholar 

  24. Tsilimparis N, Dayama A, Ricotta JJ 2nd. Remodeling of aortic aneurysm and aortic neck on follow-up after endovascular repair with suprarenal fixation. J Vasc Surg. 2015;61(1):28–34.

    Article  PubMed  Google Scholar 

  25. Mertens J, Houthoofd S, Daenens K, et al. Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft. J Vasc Surg. 2011;54(1):48.e2–.

    Article  Google Scholar 

  26. Rutherford RB. Open versus endovascular stent graft repair for abdominal aortic aneurysms: an historical view. Semin Vasc Surg. 2012;25(1):39–48.

    Article  PubMed  Google Scholar 

  27. Stather PW, Wild JB, Sayers RD, Bown MJ, Choke E. Endovascular aortic aneurysm repair in patients with hostile neck anatomy. J Endovasc Ther. 2013;20(5):623–37.

    Article  PubMed  Google Scholar 

  28. Iwakoshi S, Ichihashi S, Higashiura W, et al. A decade of outcomes and predictors of sac enlargement after endovascular abdominal aortic aneurysm repair using zenith endografts in a Japanese population. J Vasc Interv Radiol: JVIR. 2014;25(5):694–701.

    Article  PubMed  Google Scholar 

  29. Wyss TR, Dick F, Brown LC, Greenhalgh RM. The influence of thrombus, calcification, angulation, and tortuosity of attachment sites on the time to the first graft-related complication after endovascular aneurysm repair. J Vasc Surg. 2011;54(4):965–71.

    Article  PubMed  Google Scholar 

  30. Park KH, Lim C, Lee JH, Yoo JS. Suitability of endovascular repair with current stent grafts for abdominal aortic aneurysm in Korean patients. J Korean Med Sci. 2011;26(8):1047–51.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This study was supported by Inha University Research Grant.

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Authors and Affiliations

  1. Endovascular Training Center, Inha University Hospital, Incheon, Republic of Korea

    Trong Binh Le & Mi Hyoung Moon

  2. Department of Radiology, Inha University Hospital, Inha University School of Medicine, 7-206 Sinheung-dong 3-ga, Jung-gu, Incheon, Republic of Korea

    Yong Sun Jeon & Soon Gu Cho

  3. Department of Vascular Surgery, Inha University School of Medicine, Incheon, Republic of Korea

    Kee Chun Hong & Keun-Myoung Park

Authors
  1. Trong Binh Le
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  2. Mi Hyoung Moon
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Correspondence to Yong Sun Jeon.

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All authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Statement of Informed Consent

Inform consent was obtained from all individuals participants included in the study.

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Le, T.B., Moon, M.H., Jeon, Y.S. et al. Evaluation of Aneurysm Neck Angle Change After Endovascular Aneurysm Repair Clinical Investigations. Cardiovasc Intervent Radiol 39, 668–675 (2016). https://doi.org/10.1007/s00270-015-1260-7

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  • DOI: https://doi.org/10.1007/s00270-015-1260-7

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