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Long-Term Outcomes of Standard Endovascular Aneurysm Repair in Patients With Severe Neck Angulation

2018Journal article Open access
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dc.contributor.authorOliveira, N
dc.contributor.authorBastos Gonçalves, F
dc.contributor.authorHoeks, S
dc.contributor.authorJosee van Rijn, M
dc.contributor.authorUltee, K
dc.contributor.authorPinto, JP
dc.contributor.authorRaa, S
dc.contributor.authorvan Herwaarden, J
dc.contributor.authorde Vries, JP
dc.contributor.authorVerhagen, H
dc.date.accessioned2021-03-19T17:20:45Z
dc.date.available2021-03-19T17:20:45Z
dc.date.issued2018
dc.description.abstractObjective: Severe neck angulation is associated with complications after endovascular aneurysm repair (EVAR). Newer endografts may overcome this limitation, but the literature lacks long-term results. We studied the long-term outcomes of EVAR in patients with severe neck angulation. Methods: A retrospective case-control study of a prospective multicenter database was performed. All measurements were made with dedicated software with center lumen line reconstruction. A study group including patients with neck length >15 mm, infrarenal angle (β) >75 degrees or suprarenal angle (α) >60 degrees, and neck length 10 to 15 mm with β >60 degrees or α >45 degrees was compared with a control group matched for demographics and other morphologic neck features. The primary end point was type IA endoleak (EL1A). Secondary end points were freedom from neck-related secondary interventions, primary clinical success, and overall survival. Results: Forty-five patients were included in the angulated neck group and compared with 65 matched patients. Median follow-up was 7.4 years (interquartile range, 4.8-8.5 years). In the angulated neck group, mean α was 51.4 degrees (±21.1 degrees) and the mean β was 80.8 degrees (±15.6 degrees); in the nonangulated group, these were 17.9 degrees (±17.0 degrees) and 35.4 degrees (±20.0 degrees), respectively. At 7 years, five patients in the angulated neck group and two nonangulated patients developed EL1A, yielding a freedom from EL1A of 86.1% (n = 14; standard error [SE], 0.069) and 96.6% (n = 34; SE, 0.023), respectively (P = .056). After exclusion of a patient who developed an EL1A secondary to an endograft infection, this difference was significant: 86.1% (n = 14; SE, 0.069) in the angulated neck group and 98.2% (n = 34; SE, 0.018) in the nonangulated group (P = .016). At 7 years, freedom from neck-related secondary interventions was 91.7% (n = 14; SE, 0.059) and 91.6% (n = 29; SE, 0.029), respectively. The 7-year primary clinical success estimates were 41.2% (n = 11; SE, 0.085) and 56.6% (n = 20; SE, 0.072) for the angulated neck and nonangulated groups, respectively (P = .12). The 7-year survival rates were 44.3% (n = 18; SE, 0.076) vs 66.7% (n = 42; SE, 0.059) for the angulated neck and nonangulated groups, respectively (P = .25). Device integrity failure was not observed. Conclusions: Despite satisfactory results early and in the midterm, a higher rate of EL1A was identified among patients with severely angulated necks in the long term. However, mortality was not affected by this difference. These findings suggest that EVAR should be used judiciously in patients with extreme angulation of the proximal neck and highlight the need for close follow-up of EVAR, especially in the long term and in patients treated outside instructions for use.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Vasc Surg. 2018 Dec;68(6):1725-1735.pt_PT
dc.identifier.doi10.1016/j.jvs.2018.03.427pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3620
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectAgedpt_PT
dc.subjectAged, 80 and overpt_PT
dc.subjectAortic Aneurysm, Abdominalpt_PT
dc.subjectAortographypt_PT
dc.subjectBlood Vessel Prosthesispt_PT
dc.subjectComputed Tomography Angiographypt_PT
dc.subjectDatabases, Factualpt_PT
dc.subjectEndoleakpt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectNetherlandspt_PT
dc.subjectProsthesis Designpt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectRisk Factorspt_PT
dc.subjectStentspt_PT
dc.subjectTime Factorspt_PT
dc.subjectTreatment Outcomept_PT
dc.subjectBlood Vessel Prosthesis Implantationpt_PT
dc.subjectEndovascular Procedurespt_PT
dc.subjectHSM CIR VASCpt_PT
dc.titleLong-Term Outcomes of Standard Endovascular Aneurysm Repair in Patients With Severe Neck Angulationpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1735pt_PT
oaire.citation.issue6pt_PT
oaire.citation.startPage1725pt_PT
oaire.citation.titleJournal of Vascular Surgerypt_PT
oaire.citation.volume68pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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