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Endovascular repair of wide neck AAA--preliminary report on feasibility and complications
H Ingle1, G Fishwick, M M Thompson
1Department of Vascular Surgery, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, U.K.
Aim:
To assess the feasibility of endovascular repair (EVR) of wide neck abdominal aortic aneurysms (AAA).
Study Design:
Retrospective.
Method:
A cohort of patient was identified who had an AAA neck diameter of 28 mm or more and underwent EVR. These patients undergo regular follow-up by 6 monthly CT scan of abdominal aorta. Two independent observers quantified the diameter of the suprarenal aorta, the top of the neck, the bottom of the neck, the length of the neck and the transverse diameter of the AAA.
Results:
The study cohort comprised 16 patients. Bland Altman Analysis determined that the 95% interobserver limits of agreement were -4.7 to 3.3 mm. The mean preoperative diameter of the suprarenal aorta, the top of the neck and bottom of the neck all were 31 mm. On the follow-up CT scan on average after 12 months the suprarenal aorta measured 29 mm, the top of the neck 28 mm and the bottom of the neck 30 mm. There was a statistically significant decrease in the size of the top of the neck (p = 0.03).
Conclusion:
This preliminary report suggests that the endovascular repair of AAA with a wide neck is feasible with available commercial devices. The necks do not appear to increase in size and there is no increased incidence of proximal endoleak.
