Frederico M. Bastos Gonçalves1, Herman J. Zandvoort2, Joost A. van Herwaarden2, Frans L. Moll2, Debbie Werson3, Jean-Paul M. de Vries3, Hence J M. Verhagen1
1Surgery, Erasmus Medical Center, Rotterdam, Netherlands; 2Utrecht University Medical Center, Utrecht, Netherlands; 3St. Antonius Hospital, Nieuwegein, Netherlands.
OBJECTIVES: We investigate the influence of severe proximal neck angulation on mid-term outcome using the Endurant Stent Graft.
METHODS: A joint database of 3 tertiary institutions was inquired. Inclusion in the study group was: suprarenal neck angle (α) >60° or infrarenal neck angle (β) >75° (if neck length ≤10mm, α>45° or β>60°). These were compared to a matched control group without significant angulation, treated in the same period with the same device. Primary endpoint was clinical success. Three-dimensional reconstruction was used for measurements. Neck changes over follow-up (FU) were evaluated. Estimates for clinical success were obtained from Kaplan-Meier plots.
RESULTS: From 2008-2009, 232 patients were treated, and 45 were included in the study group (age 74±8, 86% men). Mean α was 51°±21 and β was 81°±16. Median FU was 3 years (2.0-3.4). Compared to the control group (n=65), no differences were found in clinical success (p=0.79, Figure 1). Two post-EVAR ruptures occurred, one in each group. No differences were found in rate or type of re-interventions. Over FU, neck dilatation >2mm occurred in 45% vs. 43% in controls (p=0.23), despite similar oversizing. Mean angulation changes in the study group were α -16°±18 and β -29°±23.
CONCLUSIONS: Severe proximal neck angulation had no influence on mid-term results when using the Endurant endograft. Device conformability resulted in minor changes in neck angulation over time, possibly reducing the risk of complications.
AUTHOR DISCLOSURES: F. M. Bastos Gonçalves: Nothing to disclose; J. M. de Vries: Nothing to disclose; F. L. Moll: Nothing to disclose; J. A. van Herwaarden: Medtronic AVE, Consulting fees or other remuneration (payment); H. M. Verhagen: Medtronic AVE, Consulting fees or other remuneration (payment); D. Werson: Nothing to disclose; H. J. Zandvoort: Nothing to disclose.
Posted April 2013