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Patients with Large Neck Diameter Have a Higher Risk of Type IA Endoleaks and Aneurysm Rupture after Standard Endovascular Aneurysm Repair

2019Journal article Open access
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dc.contributor.authorOliveira, N
dc.contributor.authorBastos Gonçalves, F
dc.contributor.authorUltee, K
dc.contributor.authorPinto, JP
dc.contributor.authorRijn, MJ
dc.contributor.authorRaa, S
dc.contributor.authorMwipatayi, P
dc.contributor.authorBöckler, D
dc.contributor.authorHoeks, S
dc.contributor.authorVerhagen, H
dc.date.accessioned2022-03-10T16:07:18Z
dc.date.available2022-03-10T16:07:18Z
dc.date.issued2019
dc.description.abstractObjective: Standard endovascular aneurysm repair (EVAR) is the most common treatment of abdominal aortic aneurysms (AAAs). EVAR has been increasingly used in patients with hostile neck features. This study investigated the outcomes of EVAR in patients with neck diameters ≥30 mm in the prospectively maintained Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE). Methods: This is a retrospective study comparing patients with neck diameters ≥30 mm with patients with neck diameters <30 mm. The primary end point was type IA endoleak (EL1A). Secondary end points included secondary interventions to correct EL1A, aneurysm rupture, and survival. Results: This study included 1257 patients (mean age, 73.1 years; 89.4% male) observed for a median 4.0 years (interquartile range, 2.7-4.8 years). A total of 97 (7.7%) patients had infrarenal neck diameters ≥30 mm and were compared with the remaining 1160 (92.3%) with neck diameters <30 mm. At baseline, there were no differences between groups regarding demographics and comorbidities other than cardiac disease, which was more frequent in the ≥30-mm neck diameter group (P = .037). There were no significant differences between the groups regarding neck length, angulation, thrombus, or calcification. Mean preoperative AAA diameter was 64.6 ± 11.3 mm in the ≥30-mm neck diameter group and 60.0 ± 11.6 mm in the <30-mm neck diameter group (P < .001). Stent graft oversizing was significantly less in the ≥30-mm neck diameter group (12.2% ± 8.9% vs 22.1% ± 11.9%; P <. 001). Five patients (5.2%) in the ≥30-mm neck diameter group and 30 (2.6%) with neck diameters <30 mm developed EL1A, yielding a 4-year freedom from EL1A of 92.4% vs 96.6%, respectively (P = .09). Oversizing was 21.8% ± 13.0% for patients developing EL1A and 21.3% ± 12.4% for the remaining cohort (P = .99). In adjusting for neck length, AAA diameter, and device oversizing, patients with neck diameter ≥30 mm were at greater risk for development of EL1A (hazard ratio, 3.0; 95% confidence interval, 1.0-9.3; P = .05). Secondary interventions due to EL1A did not differ between groups (P = .36). AAA rupture occurred in three patients with neck diameter ≥30 mm (3.1%) and in eight patients with neck diameter <30 mm (0.7%; hazard ratio, 5.1; 95% confidence interval, 1.4-19.2; P = .016); two cases were EL1A related in each group. At 4 years, overall survival was 61.6% for the ≥30-mm neck diameter group and 75.2% for the <30-mm neck diameter group (P = .009), which remained significant on correcting for sex and AAA diameter (P = .016). Conclusions: In this study, patients with infrarenal neck diameter ≥30 mm had a threefold increased risk of EL1A and fivefold risk of aneurysm rupture after EVAR as well as worse overall survival. This may influence the choice of AAA repair and underlines the need for regular computed tomography-based imaging surveillance in this subset of patients. Furthermore, these results can serve as standards with which new, possibly improved technology, such as EndoAnchors (Medtronic, Santa Rosa, Calif), can be compared.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Vasc Surg. 2019 Mar;69(3):783-791.pt_PT
dc.identifier.doi10.1016/j.jvs.2018.07.021.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3998
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectHSM CIR VASCpt_PT
dc.subjectAgedpt_PT
dc.subjectFemalept_PT
dc.subjectMalept_PT
dc.subjectHumanspt_PT
dc.subjectAged, 80 and overpt_PT
dc.subjectAortic Aneurysm / complicationspt_PT
dc.subjectAortic Aneurysm / diagnostic imagingpt_PT
dc.subjectAortic Aneurysm / mortalitypt_PT
dc.subjectAortic Aneurysm / surgerypt_PT
dc.subjectAortic Rupture / diagnostic imagingpt_PT
dc.subjectAortic Rupture / etiologypt_PT
dc.subjectAortic Rupture / mortalitypt_PT
dc.subjectBlood Vessel Prosthesispt_PT
dc.subjectBlood Vessel Prosthesis Implantation / adverse effects*pt_PT
dc.subjectBlood Vessel Prosthesis Implantation / instrumentationpt_PT
dc.subjectBlood Vessel Prosthesis Implantation / mortalitypt_PT
dc.subjectEndoleak / diagnostic imagingpt_PT
dc.subjectEndoleak / etiologypt_PT
dc.subjectEndoleak / mortalitypt_PT
dc.subjectEndovascular Procedures / adverse effects*pt_PT
dc.subjectEndovascular Procedures / instrumentationpt_PT
dc.subjectEndovascular Procedures / mortalitypt_PT
dc.subjectProduct Surveillance, Postmarketingpt_PT
dc.subjectProsthesis Designpt_PT
dc.subjectStentspt_PT
dc.subjectRegistriespt_PT
dc.subjectRisk Factorspt_PT
dc.subjectRisk Assessmentpt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectTime Factorspt_PT
dc.subjectTreatment Outcomept_PT
dc.titlePatients with Large Neck Diameter Have a Higher Risk of Type IA Endoleaks and Aneurysm Rupture after Standard Endovascular Aneurysm Repairpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage791pt_PT
oaire.citation.startPage783pt_PT
oaire.citation.titleJournal of Vascular Surgerypt_PT
oaire.citation.volume69pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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