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Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Objective

To evaluate the effectiveness of endovascular treatment of abdominal aortic aneurysms with hostile neck, comparing the results with those of patients with ideal anatomical conditions.

Materials and methods

From January 2005 to December 2013, 300 patients were treated with EVAR at our institution. Patients with a prior Angio-CT scan were included in the study and they were then retrospectively divided into two groups: patients with suitable anatomy that were treated within guidelines of the manufacturers (wIFU: 94 patients, four treated in emergency) and those with unsuitable anatomy that were treated outside of said guidelines (oIFU: 70 patients, 16 treated in emergency). Patients without prior CT study and without follow-up were excluded from the study.

Results

Postoperative mortality was 6.3 % in the wIFU group while it was 7.8 % in the oIFU group. There was not a statistically significant difference in the rate of postoperative mortality (p = 0.653). Technical success was 98.6 % in the wIFU group while it was 94.5 % in the oIFU group. All the patients of the wIFU group were treated with a stent-graft with under-renal sealing while in the oIFU group always an over-renal stent-graft was used. No deaths related to the aneurysm were highlighted at follow-up in both groups. There was a statistically significative difference between the two groups regarding intraoperative occlusion of renal arteries (wIFU = 1.1 %; oIFU = 4.7 %; p < 0.05) and in the development of type I endoleak (wIFU = 2.8 %; oIFU = 8.8 %; p < 0.05)

Conclusion

EVAR in patients with hostile neck is feasible and effective with an acceptable rate of complications.

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology “Maggiore della Carità” Hospital, University of Eastern Piedmont, C.so Mazzini 18, 28100, Novara, Italy

    Paolo Cerini, Giuseppe Guzzardi, Ignazio Divenuto, Giuseppe Parziale, Alessandro Carriero & Rita Fossaceca

  2. Vascular Surgery “Maggiore della Carità” Hospital, Novara, Italy

    Piero Brustia

Authors
  1. Paolo Cerini
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  2. Giuseppe Guzzardi
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  3. Ignazio Divenuto
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  4. Giuseppe Parziale
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  5. Piero Brustia
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  6. Alessandro Carriero
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  7. Rita Fossaceca
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Correspondence to Paolo Cerini.

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All authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Cerini, P., Guzzardi, G., Divenuto, I. et al. Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience. Radiol med 121, 528–535 (2016). https://doi.org/10.1007/s11547-016-0620-y

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  • DOI: https://doi.org/10.1007/s11547-016-0620-y

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