Endovascular Aneurysm Repair in Conical Proximal Aortic Neck Anatomy: Impact of a Conformable Endograft on Proximal Sealing Outcomes.

BACKGROUND

Conical proximal aortic neck anatomy has traditionally been considered a hostile feature for endovascular aneurysm repair (EVAR) due to concerns regarding inadequate proximal sealing and increased rates of type Ia endoleak. However, the independent impact of conical morphology and the potential mitigating role of modern conformable endografts remain debated. This study evaluates short- and mid-term outcomes of EVAR in patients with conical neck anatomy, with a specific focus on the effectiveness of the GORE Excluder Conformable endograft.

METHODS

We performed a retrospective analysis of prospectively collected data including all consecutive patients undergoing elective EVAR for infrarenal abdominal aortic aneurysm between January 2022 and December 2024. Conical neck anatomy was defined according to Delphi Consensus criteria. Outcomes were compared between patients treated with the GORE Excluder Conformable and those treated with other contemporary devices. Primary endpoints included type Ia endoleak, graft migration, and aneurysm-related mortality.

RESULTS

Among 204 EVAR procedures, 60 patients (29.4%) presented conical neck anatomy. Mean follow-up was 20 months (range, 1-34). The overall 30-day type Ia endoleak rate was 5%. Use of the GORE Excluder Conformable was associated with a significantly lower incidence of type Ia endoleak than other devices (0% vs. 9.1%, P < 0.05). No cases of graft migration or aneurysm-related mortality were observed in the Conformable group. Multivariable analysis confirmed device type as an independent protective factor against proximal sealing failure.

CONCLUSION

Conical neck anatomy alone should not be considered a contraindication to EVAR. The GORE Excluder Conformable provides a statistically significant reduction in type Ia endoleak in patients with conical proximal necks, supporting its use as a safe and effective strategy in this challenging anatomical setting.