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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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.