| Suprarenal endograft fixation avoids adverse outcomes associated with aortic neck angulation. | |
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MedLine Citation:
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PMID: 15770368 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The advent of endovascular therapy has had a profound impact on repair of abdominal aortic aneurysms (AAA). Prudent patient selection, particularly in regard to unfavorable anatomy, is emerging as perhaps the most important determinant of endovascular abdominal aortic aneurysm repair (EVAR) outcome. The aim of this study was to examine the association of one such anatomic factor, proximal aortic neck angulation, with the incidence of adverse events following EVAR. Prospectively collected data on 289 EVAR repairs with the Talent endograft (Medtronic, Inc., Minneapolis, MN) from March 1998 to June 2000 were analyzed. Stent graft-specific adverse events studied were migration, endoleak, kinking, thrombosis, and AAA expansion. Computed tomography (CT) scanning with three-dimensional post-processing and/or aortography was used to measure aortic neck angle. Patients were categorized into one of four groups according to their neck angle: I (0-10 degrees); II (11-39 degrees); III (40-59 degrees); or IV (60-85 degrees). Outcomes were evaluated by chi-squared analysis and ANOVA. There was a direct correlation between AAA diameter and neck angle (p = 0.002). There was no difference in endoleak rate (p = 0.877), stent migration (p = 0.850), or AAA expansion rate (p = 0.599) between groups. Device kinking >45 degrees was associated with neck angulation > or = 60 degrees (p = 0.013), but not with other adverse outcomes. The average neck angle was 30 degrees in patients with endoleaks and 31 degrees in patients without endoleaks. Increasing aortic neck angulation was not associated with the selected adverse outcomes within 1 year following EVAR with the Talent stent graft using suprarenal fixation with the exception of graft kinking. This may be related to the graft design that permits suprarenal aortic fixatiou of the proximal stent graft, Whether severe degrees of angulation of 60 degrees or greater can be safely treated with suprarenal fixation requires further study. |
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Authors:
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Mark Robbins; Boonprasit Kritpracha; Hugh G Beebe; Frank J Criado; Yahya Daoud; Anthony J Comerota |
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Publication Detail:
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Type: Clinical Trial; Clinical Trial, Phase II; Journal Article; Multicenter Study |
Journal Detail:
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Title: Annals of vascular surgery Volume: 19 ISSN: 0890-5096 ISO Abbreviation: Ann Vasc Surg Publication Date: 2005 Mar |
Date Detail:
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Created Date: 2005-05-03 Completed Date: 2005-06-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8703941 Medline TA: Ann Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 172-7 Citation Subset: IM |
Affiliation:
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Jobst Vascular Center, Toledo, OH 43606, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aorta, Abdominal
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pathology* Aortic Aneurysm, Abdominal / complications, radiography, surgery* Blood Vessel Prosthesis* Blood Vessel Prosthesis Implantation Female Humans Incidence Male Postoperative Complications / epidemiology* Prospective Studies Prosthesis Design Stents* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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