Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices

Abstract

Patients with HNA can be treated with EVAR, but with higher rates of early (intraoperative) type I endoleak and intervention. The midterm outcomes are similar to FNA.

Tratamento endovascular dos aneurismas da aorta abdominal com anatomia hostil: realidade e sonho

“…A proximal neck diameter > 32 mm (hazard ratio [HR] 2.07, 95% confidence interval [95% CI] 1.46-2.92) and aortic angle > 60 degrees (HR 1.96, CI 95% 1.63-2.37) predicted a subsequent increase in the diameter. 7 Although the image reviews in this retrospective and limited analysis do not reflect the rates usually reported for diameter increase of the aneurysmatic sac (40% versus approximately 10% in a period of three to five years) or the clinical significance of this finding, they represent a good example of the differences in results arising from liberal patient selection.…”

“…The frequency of hostile anatomy in this patient population can be as high as 50% to 60%. 6,7 In this issue of the Revista Brasileira de Cardiologia Invasiva, Metzger et al 8 reported their experience treating a small group of patients with hostile anatomy, defined by the presence of a strong angulation in the proximal aortic neck or in the emergence of the iliac arteries. In the authors' experience, the use of a device whose characteristics were ideal for this situation produced acceptable success and complication rates.…”

“…However, patients with hostile anatomy have a greater need for auxiliary procedures (intra-or postoperative), especially for the resolution of Type I endoleaks detected in the index procedure. 7,12 These auxiliary procedures increase costs and morbidity rates. Furthermore, enlargement of the aneurysmatic sac is very often observed as a later development.…”

“…Furthermore, enlargement of the aneurysmatic sac is very often observed as a later development. 7 In an analysis of a large database of images of endovascular treatment for abdominal aorta aneurysms, comprising over 10,000 patients treated between 1999 and 2008, the frequency of patients with major angulations and conical necks progressed throughout the years. The rates of diameter increase in the abdominal aorta aneurysm were significantly higher after 3 years of follow-up in patients treated under a liberal anatomical criterion, when compared with those who met a restricted anatomical criterion.…”

“…7,13 It is important to stress that the excellent mortality/morbidity data associated with endovascular treatment compared with open surgery apply to patients with adequate anatomy, and the chance of late events related to inadequate selection is significantly higher among patients with a hostile anatomy than among ideal cases.…”