Polymer Ring Sealing Stents for Abdominal Aortic Aneurysms with "Hostile Neck" Feature: A Safe Alternative for...

Standard endovascular aneurysm repair (EVAR) is recommended for patients "less fit" for open surgical approach but still have a reasonable life expectancy. The use of polymer ring sealing stents (ovation and ALTO) has increased since 2015 to cater for short and conical abdominal aortic aneurysm (AAA) necks with small access vessels. We reviewed the performance of those stents in the "less fit" group.

All patients with multidisciplinary team outcome (not fit for open repair) who underwent EVAR using polymer ring sealing stents since 2015 were included with completed 5 years follow-up. Clinical and radiological data were collected for patient demographics, AAA characteristics, aneurysm sac stability and/or regression, AAA rupture, surgical conversion, stent-graft complications, secondary intervention and overall survival.

Sixty-three patients who were not fit for open repair were offered polymer sealing stents. Thirty-day mortality was (1.6%). The overall annual mortality rate for year 1, 2, 3, 4 and 5 was 5.4%, 9%, 5.3%, 0%, and 24%, respectively. Satisfactory seal was achieved in 89% of the patients at 4 years with sac regression in 62% of the patients. The average reintervention rate was 2.5%. There were 2 cases of type 1 endoleak treated with limb extension and/or embolization. One patient required explantation due to infection. Only 1 patient died from AAA rupture 5 years postrepair.

Polymer ring sealing stents offer a reasonable option for patients deemed not fit for open repair with "hostile neck." Unsurprisingly, the 5-year survival in this cohort is less than standard EVAR but aneurysm-related mortality seems comparable.