Highlights
- •This single-center retrospective cohort study found that patients undergoing EVAR with the Ovation endograft present low rates of neck dilatation and neck-related complications during follow-up, irrespective of baseline neck diameter.
- •Fifty-nine patients with wide aortic necks presented similarly favorable mid-term outcomes as 222 patients with normal sized necks (type Ia endoleak 3.3% vs. 0.7%, P-value = 0.195).
- •EVAR with the Ovation endograft results in low rates of late neck related complications in patients with wide aortic neck.
Background
Patients with wide aortic necks undergoing Endovascular Aneurysm Repair (EVAR) have
been shown to be at a higher risk for neck-related complications. We aim to examine
outcomes of EVAR with an endograft exerting minimal outward pressure (Ovation-Endologix)
in patients with a large baseline neck diameter.
Methods
We performed a retrospective single center study, including consecutive patients undergoing
EVAR with the Ovation system from May 2011 to April 2021. Patients were divided in
Groups 1 and 2 if the 20, 23, 26, 29 mm or the 34 mm proximal diameter main body was
used, respectively. According to the instructions for use of the device, for neck
diameters 27–30 mm the 34 mm main body is required. Primary endpoint was rate of neck related
complications during follow-up, (type Ia endoleak, migration >10 mm and neck-related
re-interventions) and rate of aortic neck dilatation (AND). AND was determined based
on multiple aortic neck diameters that were recorded and compared between the 1-month
computed tomography angiography (CTA) after EVAR and the last available follow-up
CTA.Secondary endpoints were peri-procedural and follow-up outcomes such as endoleaks,
reinterventions and overall mortality.
Results
In total 281 patients were included, 222 in Group 1 and 59 in Group 2. Patients in
Group 2 presented significantly shorter neck length, higher neck angulation and more
common reversed tapered configuration. Median follow-up was 36 months (Range: 6–106).
Early and late type Ia endoleak was observed in 4 and 2 patients in each group, respectively
(P = 0.063 and P = 0.195, respectively). Distal migration was observed in 2 patients in Group 2 and
AND was recorded in 2 patients in each group (P = 0.195). Freedom from the primary endpoint was estimated at 98%, 94%, 94% at 12-,
36-, 60-months for Group 1 and at 98%, 95%, 86% for Group 2 (P-Value 0.266). Probability of survival was 95%, 86%, 75% at 12-, 36-, 60-months for
Group 1 and 83%, 77%, 72% for Group 2 (P-Value 0.226).Multivariate regression analysis identified neither Group 1 versus Group
2 nor absolute value of aortic neck diameter as significant predictors of neck-related
adverse events. Neck diameters did not display significant differences over time in
any of the levels evaluated.
Conclusions
EVAR with the Ovation endograft results in low rates of late neck related complications
which is also true for patients with wide baseline aortic necks.
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References
- Editor's choice - European society for vascular surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.Eur J Vasc Endovasc Surg. 2019; 57: 8-93
- Infrarenal endovascular aneurysm repair with large device (34- to 36-mm) diameters is associated with higher risk of proximal fixation failure.J Vasc Surg. 2019; 69: 385-393
- Standard endovascular aneurysm repair in patients with wide infrarenal aneurysm necks is associated with increased risk of adverse events.J Vasc Surg. 2017; 65: 1608-1616
- Outcomes of endovascular aneurysm repair performed in abdominal aortic aneurysms with large infrarenal necks.J Vasc Surg. 2017; 66: 1065-1072
- Large diameter (≥29 mm) proximal aortic necks are associated with increased complication rates after endovascular repair for abdominal aortic aneurysm.Ann Vasc Surg. 2019; 60: 70-75
- Risk factors, dynamics, and clinical consequences of aortic neck dilatation after standard endovascular aneurysm repair.Eur J Vasc Endovasc Surg. 2021; 62: 26-35
- A systematic review of proximal neck dilatation after endovascular repair for abdominal aortic aneurysm.J Endovasc Ther. 2017; 24: 59-67
- Factors affecting the occurrence of proximal endoleak after endovascular abdominal aortic repair for abdominal aneurysms.J Intmedres. 2020; 48 (300060520971515)
- The polymer-based technology in the endovascular treatment of abdominal aortic aneurysms.Polymers (Basel). 2021; 13: 1196
- Aortic neck evolution after endovascular repair with TriVascular Ovation stent graft.J Vasc Surg. 2016; 63: 8-15
- Five-year results of endovascular abdominal aortic aneurysm repair with the Ovation abdominal stent graft.J Vasc Surg. 2020; 71: 1528-1537
- Treatment of abdominal aortic aneurysm with a new type of polymer-filled low profile device.Int J Surg. 2013; 11 Suppl 1: S24-S29
- Ultra-low profile polymer-filled stent graft for abdominal aortic aneurysm treatment: a two-year follow-up.Radiol Med. 2015; 120: 542-548
- Improvement of patient eligibility with the use of new generation endografts for the treatment of abdominal aortic aneurysms. A comparison study among currently used endografts and literature review.Expert Rev Med Devices. 2017; 14: 245-250
- An update on the improvement of patient eligibility with the use of new generation endografts for the treatment of abdominal aortic aneurysms.Expert Rev Med Devices. 2020; 17: 1231-1238
- The ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives.Expert Rev Med Device. 2016; 13: 253-262
- An update on the ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives.Expert Rev Med Device. 2020; 17: 1249-1256
- Tsetis DK.going beyond current AAA neck angulation limitations of the ovation ultra-low profile polymer-filled stent graft.Eur J Vasc Endovasc Surg. 2016; 52: 172
- Parallel grafts to treat juxtarenal aneurysms using the ovation stent graft system.Eur J Vasc Endovasc Surg. 2020; 60: 479
- The chimney technique with the Ovation abdominal stent graft system: an ideal platform for self-expandable renal stents?.Cardiovasc Interventradiol. 2014; 37: 1393-1394
- The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.J Vasc Surg. 2018; 67: 2-77
- Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair.J Vasc Surg. 2002; 35: 1061-1066
- Computed tomographic angiographic imaging of abdominal aortic aneurysms: implications for transfemoral endovascular aneurysm management.J Vasc Surg. 1997; 26: 231-237
- Bifurcated aortoiliac endograft limb occlusion during deployment and its bailout conversion using the external iliac artery to internal iliac artery endograft technique.Ann Vasc Surg. 2015; 29: 1029-1034
Chaikof EL, Blankensteijn JD, Harris PL, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg;35:1048–1060.
- Prognostic significance of large diameter proximal aortic neck in endovascular aneurysm repair.Vasa. 2020; 49: 215-224
- Endovascular aneurysm repair in patients with a wide proximal aortic neck: a systematic review and meta-analysis of comparative studies.J Cardiovasc Surg (Torino). 2019; 60: 167-174
- Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta aneurysm repair with self-expandable stent-grafts.J Vasc Surg. 2003; 37: 1200-1205
- Rate of female patients treated for Abdominal Aortic Aneurysm may beextremely low in specific populations.J Vasc Endovasc Surg. 2021; 3: 43-47
Article Info
Publication History
Published online: July 31, 2022
Accepted:
June 26,
2022
Received:
April 18,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of interest: None.
Funding sources: None.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
