J Korean Soc Radiol.  2012 Nov;67(5):323-332. 10.3348/jksr.2012.67.5.323.

Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

• Jung HD
• Lee YY
• Lee SJ
• Lim JH
• Yim NY
• Chang NK
• Kim JK
• Choi SJ
• Jung SY

• KMID: 1819747
• DOI: http://doi.org/10.3348/jksr.2012.67.5.323

Abstract

PURPOSE
To evaluate the outcomes and find the prognostic factors of endovascular abdominal aortic aneurysm repair (EVAR) in patients with hostile neck anatomy of the abdominal aorta.
MATERIALS AND METHODS
This study was performed on 100 patients with abdominal aneurysm who were treated with EVAR between March 2006 and December 2010. We divided the patients into two groups: good neck anatomy (GNA), and hostile neck anatomy (HNA) and then compared the primary success rate and the incidence rate of complications with EVAR between the two groups. Our aim was to determine the factors related to the complications of EVAR among HNA types.
RESULTS
There were no significant differences of primary success rate and incidence rate of complications between the two groups. Among the types of HNA, the short neck angle [odd ratio (OR), 4.23; 95% confidence interval (CI), 1.21-18.70; p = 0.023] and large neck angle (OR, 2.58; 95% CI, 0.15-11.85; p = 0.031) showed a low primary success rate. The short neck angle (OR, 2.32; 95% CI, 1.18-12.29; p = 0.002) and large neck angle (OR, 4.67; 95% CI, 0.14-19.07; p = 0.032) showed a high incidence rate of early type 1 complication. In the case of the large neck angle (OR, 3.78; 95% CI, 0.96-20.80; p = 0.047), the large neck thrombus (OR, 2.23; 95% CI, 0.24-7.12; p = 0.035) and large neck calcification (OR, 2.50; 95% CI, 0.08-18.37; p = 0.043) showed a high incidence rate of complications within a year.
CONCLUSION
The results suggest that patients with hostile neck anatomy can be treated with EVAR successfully, although there was a higher incidence of complications in patients with a short neck length, severe neck angulation, circumferential thrombosis, and calcified proximal neck.

MeSH Terms

Aneurysm
Aortic Aneurysm, Abdominal
Humans
Incidence
Neck
Thrombosis

Figure

• 

  Fig. 1 No hostile neck features, a 59-year-old man. A. Volume rendering image shows infrarenal abdominal aortic aneurysm (sac diameter: 42 mm) with aneurysmal dilatation of left common iliac artery (arrow). There is no adverse feature in the proximal aortic neck. B. Completion angiogram shows successful deployment of Zenith® 32-118-12 mm. C. Three months after EVAR, there was no complication on follow up CT image. Note.-EVAR = endovascular abdominal aortic aneurysm repair

• 

  Fig. 2 One hostile neck feature, an 84-year-old man. A. Volume rendering image shows infrarenal abdominal aortic aneurysm (sac diameter: 46 mm) with aneurysmal dilatation of both common iliac arteries. Neck angulation is 84°. B. Completion angiogram shows no immediate complication after deployment of Zenith® 28-133-12 mm. C. Six months after EVAR, there was no complication on follow up abdomen CTA. Note.-CTA = CT angiography, EVAR = endovascular abdominal aortic aneurysm repair

• 

  Fig. 3 Two hostile neck features, an 85-year-old man. A. Volume rendering image shows infrarenal abdominal aortic aneurysm (sac diameter: 48 mm) with calcified proximal neck and conical neck. B. Follow up angiogram shows Type Ia endoleak (arrow) after deployment of Zenith® 30-155 mm. C. After deployment of aortic ring (14-90 mm), type Ia endoleak was improved. D. After 1 month, there was no complication on follow up abdomen CTA. Note.-CTA = CT angiography

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