The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients

Background: Initially, patients with a short angulated aortic neck were considered unfit for endovascular aneurysm repair (EVAR). Recently, however, more liberal use of EVAR has been advocated. This study analyzes the correlation of aortic neck length to early and late outcomes. Methods: We analyzed 238 patients who underwent EVAR during a recent 7-year period. All patients were followed up clinically and underwent postoperative duplex ultrasound imaging or computed tomography angiography, which were repeated every 6 months. Aortic neck length was classified into >= 15 mm (L1, n = 195), 10 to < 15 mm (L2, n = 24), and <10 mm (L3, n = 17). Kaplan-Meier methods were used to estimate freedom from late endoleak, early and late reintervention, and survival. Results: Analyzed were 49 Ancure, 47 AneuRx, 104 Excluder, and 38 Zenith grafts. The mean follow-up was 24.7 months (range, 1-87 months). The initial technical success was 99%. The perioperative complication rates for groups L1, L2, and L3 were 13%, 21%, and 24%, respectively (P = .289). Proximal type I early endoleaks occurred in 12%, 42%, and 53% in groups L1, L2, and L3, respectively (P < .001). Intraoperative proximal aortic cuffs were needed to seal proximal type I endoleaks in 10%, 38%, and 47% in L1, L2, and L3 groups, respectively (P < .0001). However, the rate of late reintervention was comparable in all groups. Postoperatively, the size of the abdominal aortic aneurysm decreased or remained unchanged in 95%, 94%, and 88% in L1, L2, and L3, respectively (P = .660). Rates of freedom from late type. I endoleak at 1, 2, and 3 years were 84%, 82%, and 80% for L1; 68%, 54%, and 54% for L2; and 71%, 71%, and 53% for L3 (P = .0263). Rates of freedom from late intervention at 1, 2, and 3 years were 96%, 94%, and 92% for L1; and 94%, 83%, and 83% for L2; and 93%, 93%, and 93% for L3 (P = .5334). Conclusions: EVAR can be used for patients with a short aortic neck; however, it was associated with a significantly higher rate of early and late type I endoleaks, resulting in an increased use of proximal aortic cuffs for sealing the endoleaks. (J Vasc Surg 2009;50:738-48.)