Early and mid-term results of endovascular abdominal aortic aneurysm repair with hostile proximal neck anatomy

• Osipova O.S.
• Rabtsun A.A.
• Efi mova-Syakina K.A.
• Cheban A.V.
• Gostev A.A.
• Saaya Sh.B.
• Ignatenko P.V.
• Karpenko A.A.

Abstract

Background. Currently, there are no exact recommendations on the possibility of performing endovascular repair of an abdominal aortic aneurysm if the requirements for the anatomy of its proximal neck go beyond the recommended criteria.

Objective. The aim of our study was to evaluate the immediate and mid-term results of endovascular repair of an abdominal aneurysm with hostile anatomy of its proximal neck.

Patients and methods. We retrospectively analyzed therapeutic outcomes in 88 patients who underwent endovascular abdominal aortic aneurysm repair with a hostile proximal landing zone. The stent grafts implanted into the patients were as follows: Seal, Zenith Alpha, ELLA, Ovation Prime, Anaconda, Endurant. The outcome measures comprised the incidence of clinically significant complications, reoperations, and mortality within 2 years after surgery.

Results. The study included a total of 88 patients, of whom there were 75 (85%) men and 13 (15%) women. A conical neck of the aneurysm was present in 12 (14) patients. Parietal thrombotic masses in the zone of proximal fixation were moderately pronounced (<50% of the circumference) in 33 (38%) cases and significantly pronounced (50% and more of the circumference) in eight (9%) cases. Moderate angulation from 60° to 75° was observed in ten (11%) patients, with pronounced neck angulation of 75° and more encountered in six (7%) patients. Calcification of more than 50% of the cervical circumference was observed in 66 (75%) patients. An aneurysm neck length of less than 10 mm was observed in four (5%) cases.

The technical success of the operation was achieved in 98.86% of cases. One (1%) patient developed thrombosis of the endograft limb in the early postoperative period. The 2-year primary patency of the stent-grafts was 82.95%. The total number of endoleaks during the in-hospital and mid-term postoperative periods did not differ significantly, amounting to 20 (22.72%) and 24 (27.27%), respectively (p=0.60). The presence of parietal thrombotic masses in the area of the proximal neck increased the risk of thrombosis of the stent-graft limbs in the postoperative period [RR 5.03 (1.28; 19.81), p=0.02]. Angulation of the proximal aneurysm neck elevated the risk of endoleaks [RR 1.55 (1.06; 5.30), p=0.04].

Conclusion. Endovascular abdominal aortic aneurysm repair in hostile anatomy of the proximal landing zone is a safe and effective method of treatment, with a technical success rate of 98.86%. It was found that angulation in the area of the proximal aneurysmal neck contributed to the development of endoleaks in the mid-term follow-up period, with thrombotic masses in the region of the proximal neck of the aneurysm being predictive factors for thrombosis of the stent-graft limbs.

Funding. This study was financially supported by the Russian Science Foundation grant 21-15-00091.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Karpenko A.A., Rabtsun A.A., Osipova O.S., Ignatenko P.V.; data collection and handling – Rabtsun A.A., Efimova–Syakina K.A., Osipova O.S., Cheban A.V., Gostev A.A., Saaya Sh.B.; statistical processing – Rabtsun A.A., Gostev A.A., Osipova O.S., Saaya Sh.B.; draft manuscript preparation – Osipova O.S., Rabtsun A.A., Efimova-Syakina K.A.; manuscript revision – Karpenko A.A., Osipova O.S., Ignatenko P.V.

Acknowledgments. The authors express their sincere thanks to Aivazov Sakhib Allaz ogly, a resident physician of the “Novosibirsk State Medical University” of the RF Ministry of Public Health, for help in data collection.

For citation: Osipova O.S., Rabtsun A.A., Efimova–Syakina K.A., Cheban A.V., Gostev A.A., Saaya Sh.B., Ignatenko P.V., Karpenko A.A. Early and mid-term results of endovascular abdominal aortic aneurysm repair with hostile proximal neck anatomy. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 102–7. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-102-107

Keywords:aorta; aneurysm; endovascular treatment; endovascular aneurysm repair; stent-graft