Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

To evaluate the effectiveness of endovascular treatment of abdominal aortic aneurysms with hostile neck, comparing the results with those of patients with ideal anatomical conditions.

From January 2005 to December 2013, 300 patients were treated with EVAR at our institution. Patients with a prior Angio-CT scan were included in the study and they were then retrospectively divided into two groups: patients with suitable anatomy that were treated within guidelines of the manufacturers (wIFU: 94 patients, four treated in emergency) and those with unsuitable anatomy that were treated outside of said guidelines (oIFU: 70 patients, 16 treated in emergency). Patients without prior CT study and without follow-up were excluded from the study.

Postoperative mortality was 6.3 % in the wIFU group while it was 7.8 % in the oIFU group. There was not a statistically significant difference in the rate of postoperative mortality (p = 0.653). Technical success was 98.6 % in the wIFU group while it was 94.5 % in the oIFU group. All the patients of the wIFU group were treated with a stent-graft with under-renal sealing while in the oIFU group always an over-renal stent-graft was used. No deaths related to the aneurysm were highlighted at follow-up in both groups. There was a statistically significative difference between the two groups regarding intraoperative occlusion of renal arteries (wIFU = 1.1 %; oIFU = 4.7 %; p < 0.05) and in the development of type I endoleak (wIFU = 2.8 %; oIFU = 8.8 %; p < 0.05) CONCLUSION: EVAR in patients with hostile neck is feasible and effective with an acceptable rate of complications.