Gaceta medica de Mexico · 2014
[Single-center Experience of Endovascular Abdominal Aortic Aneurysm Treatment in Patients with Hostile Neck Anatomy versus Favorable Anatomy].
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Montes Carmona Melisa, Carbajal Contreras Gustavo, Murillo Barrios Iván Enrique, Sánchez Escalante Luis Ricardo
Аннотация
BACKGROUND: Endovascular aneurysm repair (EVAR) generally is not recommend for patients with unfavorable neck anatomy. This study examines the short-term results according to the characteristics of the proximal aortic neck treated with EVAR.
METHODS: Between December 2010 and January 2013, 21 patients were treated with EVAR. Patients were classified as those with favorable neck anatomy (FNA) and hostile neck anatomy (HNA). The parameters for HNA were considered as one or more of the following criteria: neck length < 15 mm, angle > 60°, diameter > 28 mm, ≥ 50% of thrombus in the proximal neck circumference, inverted tapered neck. Clinical and demographic characteristics were compared within the short-term (30 days).
RESULTS: A total of 47.7% of the stents were placed in FNA. Perioperative complications were vascular injury and bleeding, which occurred at the same frequency in both groups, and postoperative complications were acute renal failure and pulmonary complications in both groups. The mortality rate was 0% FNA vs. 20% ANA. Intraoperative type I endoleaks occurred in FNA in one case (9%) and HNA in two cases (20%). The cuffs were used in the FNA endoleak and in a HNA case and the other case was treated by angioplasty over dilatation subsequently presenting early endoleak.
CONCLUSIONS: Patients presenting a hostile neck are at increased risk of complications related to endoleaks and second interventions, so close monitoring of these patients should be maintained. However, no incidence of open surgical conversion, rupture, or death related to aortic aneurysm was seen. This being so, it is possible to treat these patients with challenging aortic characteristics. Increased vigilance in these patients should be considered.
METHODS: Between December 2010 and January 2013, 21 patients were treated with EVAR. Patients were classified as those with favorable neck anatomy (FNA) and hostile neck anatomy (HNA). The parameters for HNA were considered as one or more of the following criteria: neck length < 15 mm, angle > 60°, diameter > 28 mm, ≥ 50% of thrombus in the proximal neck circumference, inverted tapered neck. Clinical and demographic characteristics were compared within the short-term (30 days).
RESULTS: A total of 47.7% of the stents were placed in FNA. Perioperative complications were vascular injury and bleeding, which occurred at the same frequency in both groups, and postoperative complications were acute renal failure and pulmonary complications in both groups. The mortality rate was 0% FNA vs. 20% ANA. Intraoperative type I endoleaks occurred in FNA in one case (9%) and HNA in two cases (20%). The cuffs were used in the FNA endoleak and in a HNA case and the other case was treated by angioplasty over dilatation subsequently presenting early endoleak.
CONCLUSIONS: Patients presenting a hostile neck are at increased risk of complications related to endoleaks and second interventions, so close monitoring of these patients should be maintained. However, no incidence of open surgical conversion, rupture, or death related to aortic aneurysm was seen. This being so, it is possible to treat these patients with challenging aortic characteristics. Increased vigilance in these patients should be considered.