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 PS20. Endovascular Repair Using Standard Suprarenal Fixation Endograft is Feasible and Effective in Abdominal Aortic Aneurysm with Infra-renal Neck Length 5-10 mm

​Mauro Gargiulo1, Enrico Gallitto1, Claudio Bianchini Massoni1, Antonio Freyrie1, Gianluca Faggioli1, Carla Serra1, Joseph J. Ricotta2, Andrea Stella1
1Vascular Surgery, University of Bologna, Bologna, Italy; 2Vascular Surgery, Emory University, Atlanta, GA.

OBJECTIVES: To evaluate early and intermediate outcomes of endovascular aneurysm repair (EVAR) using standard suprarenal fixation endograft in abdominal aortic aneurysm (AAA) with infra-renal neck length 5-10 mm (short neck- SN)

METHODS: Clinical, morphological and surgical data of patients undergoing EVAR for AAA with SN between 2005 and 2011 were analyzed. Endpoints included technical (TS) and clinical success (CS) according to the Reporting Standard for EVAR, intra-operative proximal cuff placement (CP), peri-operative renal function, proximal type I endoleak (ELIa), AAA shrinkage, freedom from re-intervention and long-term survival. Follow-up was conducted by duplex ultrasound (US), contrast enhancement US (CEUS) and CTA at 1, 6, 12 months and yearly thereafter

RESULTS: Sixty patients (mean age 75 years, male 88%, ASAIII/ASAIV:85%/13%) were identified. Mean aneurysm diameter, mean neck length and diameter were 60.4±12.2mm, 8.4±1.6mm and 23.5±3mm respectively. We implanted 32 (53.3%) Cook-Zenith™ endograft and 28 (46.7%) Medtronic-Endurant™ endograft. TS and CS were 97% and 93%. We performed 4 (7%) CP. No significant differences between pre and peri-operative renal function were detected. Mean follow-up was 27 months (range: 6-56). Two (3%) ELIa were observed at 1month. A significant mean AAA shrinkage of 9±7.2mm was observed (p<.001). Freedom from re-intervention and overall survival at 12, 24 and 36 months were 96%,93%,93% and 95%,95% and 89% respectively. No late ELIa were observed. Intra-operative CP was associated with α-neck angle ≥60°(p=.046). Postoperative ELIa was associated with coexisting α-neck angle ≥60° and neck calcification/thrombosis (p=.033)

CONCLUSIONS: EVAR in AAA with SN using standard suprarenal endograft is feasible and effective with high TS and CS. AAA with SN and α-neck angle ≥60° is associated with an increased rate of CP while coexisting α-neck angle ≥60° and neck calcification/thrombosis is a risk factor for ElIa

AUTHOR DISCLOSURES: C. Bianchini Massoni, Nothing to disclose; G. Faggioli, Nothing to disclose; A. Freyrie, Nothing to disclose; E. Gallitto, Nothing to disclose; M. Gargiulo, Nothing to disclose; J. J. Ricotta, Nothing to disclose; C. Serra, Nothing to disclose; A. Stella, Nothing to disclose.

Posted April 2012

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