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Friendly Neck Anatomy Does Not Prevent Neck-Related Adverse Events After EVAR.

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Endovascular aneurysm repair (EVAR) follow-up needs risk stratification. Hostile neck anatomy did not predict long-term adverse events, but large aneurysm diameter increased risks, necessitating close monitoring.

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Area of Science:

  • Vascular Surgery
  • Medical Imaging
  • Patient Outcomes

Background:

  • Life-long follow-up after endovascular aneurysm repair (EVAR) is costly and burdensome.
  • Stratified follow-up based on EVAR failure risk is needed.
  • Aneurysm neck anatomy is a key factor in EVAR success.

Purpose of the Study:

  • To investigate aneurysm neck anatomy as a predictor of neck-related adverse events after EVAR.
  • To assess the long-term impact of neck anatomy on EVAR outcomes.
  • To identify risk factors for adverse events following EVAR.

Main Methods:

  • Retrospective single-center study of 222 patients undergoing EVAR for infrarenal abdominal aortic aneurysms (2011-2016).
  • Yearly imaging follow-up until December 2020.
  • Hostile neck defined by length, width, angulation, calcification, thrombus, or conical shape; neck-related adverse events included rupture, reintervention, or type 1a endoleak.

Main Results:

  • 41% of patients had hostile neck anatomy; no significant difference in 30-day mortality or major adverse events.
  • Survival rates were lower at 1 and 5 years for hostile neck patients; aneurysm-related mortality was higher after 6 years.
  • Aneurysm diameter ≥70 mm was an independent risk factor, associated with a nearly 4-fold increased risk of neck-related complications.

Conclusions:

  • Friendly neck anatomy may not guarantee protection from long-term neck-related adverse events after EVAR.
  • Patients with large aneurysms (≥70 mm) require particularly close long-term follow-up.
  • Risk stratification beyond neck anatomy, considering aneurysm size, is crucial for EVAR management.