Endovascular repair of abdominal aortic aneurysm with hostile proximal neck anatomy / 中华放射学杂志

ABSTRACT

Objective To analyze the safety and efficacy of endovascular aortic repair (EVAR) for abdominal aortic aneurysm(AAA) with hostile aortic proximal landing anatomy. Methods The clinical and imaging data of 147 AAA patients [135 males, (68.7 ± 8.9) years old, range 43-85 years old] with hostile aortic proximal landing anatomy treated by EVAR from January 2012 to December 2014 in our center were retrospectively analyzed. The range of maximum aneurysm diameter was 45-100 mm; the length range of proximal aneurysm neck was 7-32 mm;the width range of proximal aneurysm neck was 15-30 mm, and the infrarenal angulation was 10°-90° . In addition, there were atherosclerotic changes in the proximal neck in 43 cases. Follow-up protocol consisted of evaluation of clinical symptoms and cTA at 3, 6 and 12 months and annually thereafter. Results The technical success rate was 100%. Different procedures were adopted among patients, with 113 cases of EVAR, 3 cases of fenestrated EVAR and 24 cases of chimney EVAR. The intra-operative type Ia endoleak was observed in 32 cases, in which 25 of them were successfully treated by balloon angioplasty and the other 9 patients were treated with Cuff extension. During the mean follow-up period of 18 months (6-42 months), the accumulative survival rate was 98.0%(144/147),the patency rate of stents was 99.3%(146/147), and the thrombosis rate of aneurysm was 97.3%(143/147). Two patients died because of aneurysm rupture, and another case died of unknown reason. Two patients underwent secondary intervention successfully for the treatment of thrombosis formation and lumen occlusion in unilateral iliac stent in 1 case, and type Ⅲ endoleak in another case. No other complications such as misplace of stent grafts, no bilateral limb ischemia and stent infection were observed during follow-up. Conclusions EVAR is a safe and effective option to treat AAA with hostile aortic proximal landing anatomy. Choosing the most suitable stent-graft, the combination of various interventional techniques and close postoperative follow-up are the key points for successful treatment.