Expert Opinion on Hostile Neck Definition in Endovascular Treatment of Abdominal Aortic Aneurysms (a Delphi Consensus)

Endovascular aortic repair with the Gore Excluder Conformable endograft in severe neck angulation: Preliminary experience and technical aspects

“…Currently more than 75% of cases of AAA are treated by endovascular approach in European vascular centers. 3 Up to 58% of them are treated outside IFU, mostly related to “hostile neck” anatomy. 2 Infrarenal aortic neck angulation is often associated with EVAR failure related to proximal EL and migration.…”

“…2 Several authors defined various hostility criteria and considered an infrarenal neck angulation more than 60° an unfavorable anatomy for EVAR with an angulation between 75° and 90° as an additional risk factor. 3–5 With increasing operator experience and new material availability, endografts instruction for use (IFU) are nevertheless broadened today to allow treatment of most patients anatomies even if up to 58% of EVAR are nowadays performed outside manufacturers’ indications for use. 2…”

Carotid endarterectomy should be performed first rather than combined with coronary bypass

“…The Society of Thoracic Surgeons CABG outcomes, either isolated or combined with CEA, in patients with carotid disease also reveal no differences in stroke or death. 2 On-pump adjusted mortality was 3% to 4% for both groups, with stroke 4%. Off-pump adjusted results were 2% to 3% for both mortality and stroke.…”

Reply

“…According to the literature, Asian patients have longer infrarenal abdominal aortas, longer abdominal aortic aneurysm (AAA) centerlines, larger AAA neck outer diameters, and shorter proximal necks compared with white patients. 2,3 It appears that the angle between the aneurysm and the aortic axis is smaller, whereas the linear distance from the renal artery to the aortoiliac bifurcation is greater. In addition, Asians appear to have more tortuous infrarenal aortas, rendering more challenging the intraoperative maneuvers for the current delivery devices.…”

“…4 Keeping in mind the documented morphologic differences of the aortoiliac axis between white and Asian AAA patients, one can assume that an important factor contributing to the increase of the procedural complexity refers to the anatomic features. 2 Furthermore, the common iliac arteries appear to be wider and significantly shorter (particularly on the right side) in Asians, making these patients prone to type IB endoleak. [2][3][4] The Treovance aortic stent graft has a main body that comes in three lengths: 80, 100, and 120 mm.…”