Print this pageOutcomes Of Endovascular AAA Repair In Patients With Challenging Aortic Necks That Require Adjunctive Procedures During the Initial Repair
Back to Program
Manish Mehta, R Clement Darling, III, Yaron Sternbach, John B Taggert*, Philip SK Paty*, Sean P Roddy, Paul B Kreienberg*, Kathleen J Ozsvath*, Benjamin B Chang*, Dhiraj M Shah
Albany Medical College, Albany, NY
Purpose:
Patients with challenging infrarenal aortic neck for endovascular aneurysm repair (EVAR) often require adjunctive procedures (Palmaz stents, modified fenestrated stentgrafts, and aneurysm embolization) to obtain adequate stentgraft fixation and seal. We evaluated the mid-term outcomes of patients that required these adjunctive procedures during the initial EVAR.
Methods:
From 2002-2005, 823 patients underwent EVAR with a variety of commercially available stentgrafts (AneuRx, Excluder, Zenith), and 296 (36%) of these patients had challenging aortoiliac anatomy that would have precluded them from pivotal stentgraft trials. Forty-six (16%) of 296 patients had challenging proximal aortic neck morphology that required the additional placement of a Palmaz stent (n=32, 70%), modified fenestrated stentgrafts (n=8, 17%), and coil embolization of the aneurysm sac (n=6, 13%) for treatment of type 1 endoleaks. Data was prospectively collected and patients underwent routine follow-up with CT angiography every 6 months. Patients with persistent type 1 endoleak, or significant stentgraft migration, underwent secondary interventions.
Results:
Following the initial procedure, 4 (9%) patients with Palmaz stents had major complications; 2 developed renal failure, and 2 died from diffuse systemic embolization. Over a mean follow-up of 24 months, 8 (17%) patients required additional secondary procedures for persistent type 1 endoleak, there were no aneurysm ruptures, and 1 patient underwent successful conversion to open surgical repair.
| Adjunctive Procedures | n | Additional 2° Procedures | AAA rupture |
| Palmaz Stent | 32 | 6 (19%), AAA embolization | 0 |
| Fenestrated Stentgraft | 8 | 0 | 0 |
| AAA Embolization | 6 | 2 (33%), Fenestrated stentgrafts | 0 |
Conclusions: Majority of patients with challenging aortic neck morphology can me managed with adjunctive procedures during the initial EVAR. Midterm data suggests that 17% of these patients might require additional secondary procedures, and a vast majority of these can be managed by endovascular means with a limited morbidity and mortality.
Back to Annual Meeting
Back to Program