Outcomes of Endovascular Aneurysm Repair in Patients with Hostile Neck Anatomy

Objectives: This study aims to evaluate outcomes following EVAR in patients with hostile neck anatomy (HNA). Methods: Data prospectively collected from 552 elective EVARs were analysed, retrospectively. Data regarding neck morphology was obtained from aneurysm stent plans produced prior to EVAR. HNA was defined as any of neck diameter >28 mm, neck angulation >60 degrees neck length <15 mm, neck thrombus, or neck flare. Results: 552 patients underwent EVAR. Mean age 73.9 years, mean follow-up 4.1 years 199 patient had HNA, 353 had favourable neck anatomy (FNA). There was a significant increase in late type I endoleaks (FNA 4.5%, HNA 9.5%; P = 0.02) and total reinterventions (FNA 11.0%, HNA 22.8%; P < 0.01), and a significant decrease in late type II endoleaks in patients with HNA (FNA 16.7%, HNA 10.6%; P < 0.65). There was no significant difference in technical success (FNA, 0.6%, HNA 2.0%; p = 0.12); 30-day re-intervention (FNA 2.8%, HNA 5.0%; P = 0.12), 30-day mortality (FNA 1.1%, HNA 0.5%; P = 0.45), 30-day type I endoleaks (FNA 0.8%, HNA 2.5%; P = 0.12), 5-year mortality (FNA 15.1% HNA 14.6%; P = 0.86), aneurysm-related mortality (FNA 1.7% versus HNA 2.0%; P = 09), stent-graft migration (FNA 2.5%, HNA 3.6%; P = 0.75), sac expansion (FNA 13.0%, HNA 9.5%; P = 0.22), or graft rupture (FNA 1.1%, HNA 3.5%; P = 0.05). Binary logistic regression of individual features of HNA revealed secondary intervention (P = 0.009), technical failure (P = 0.02), and late type I endoleaks (P = 0.002), were significantly increased with increased neck diameter. Conclusions: HNA AAAs can be successfully treated with EVAR. However, surveillance necessary to detect and treat late type I endoleaks in HNA patients. (c) 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.