Endovascular Treatment of Abdominal Aortic Aneurysm with Hostile Artery Access: A Multi-Center Retrospective Study

The objective of this study is to document our experience using low-profile endografts for the endovascular repair of abdominal aortic aneurysms (AAAs) in cases where access arteries are challenging, commonly referred to as hostile access arteries.

Data regarding patients with narrow or tortuous access arteries who underwent endovascular aortic repair (EVAR) using low-profile endografts at 3 tertiary medical centers between January 2020 and December 2022 were retrospectively collected and analyzed. A total of 76 patients were enrolled in the study. The primary endpoints included technical success, occurrence of endoleaks, endograft occlusion, and any device- or procedure-related major adverse events. Secondary endpoints were assessed for endograft migration, endograft fracture, access site complications, and aneurismal sac shrinkage.

The mean follow-up duration was 28.1 ± 9.0 months (range, 14.0-54.0). Among the patients, 32 (42.1%) had narrow artery access (diameter ≤6.0 mm), 29 (38.2%) had access arteries characterized by tortuosity, and 15 (19.7%) patients presented with both narrow and tortuous access arteries. Technical success was achieved in 73 (96.1%) cases. A total of 4 (5.2%) patients received reintervention due to endograft occlusion. During follow-up, a total of 8 (10.5%) type II endoleaks were observed during follow-up without intervention, and the endoleak disappeared in the follow-up period. Abdominal aortic aneurysm-sac shrinkage and stability were observed in 25 (32.9%) and 51 (67.1%) cases, respectively. The overall survival rate was 98.7%. The perioperative and follow-up outcomes for the groups categorized by 'Narrow arteries', 'Tortuous arteries', and 'Narrow and Tortuous arteries' did not show statistically significant differences when compared to each other.

This preliminary investigation indicates that the use of low-profile endografts is associated with safety and effectiveness within the observed period.