Outcomes of endovascular aortic aneurysm repair in patients with hostile neck anatomy

Transcription

1 Outcomes of endovascular aortic aneurysm repair in patients with hostile neck anatomy Poster No.: C-2033 Congress: ECR 2010 Type: Scientific Exhibit Topic: Interventional Radiology Authors: Y. R. Choi, N.-K. Chang, H. J. Oh, J. K. Kim ; Jeollanam-do/ KR, Gwang-ju/KR Keywords: Aortic Aneurysm, Endovascular repair, Hostile neck DOI: /ecr2010/C-2033 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 30

2 Purpose The advent of endovascular therapy has a profound impact on repair of abdominal aortic aneurysm (AAA) The feasibility of endovascular aneurysm repair (EVAR) is dependent on the morphology of the aorta The most important anatomic determinant for EVAR is the anatomic morphology of proximal aortic neck Definition of Hostile neck Neck diameter > 26 mm Neck angulation > 60 # Neck length (landing zone) < 10 mm Circumferential thrombosis > 50% To Evaluate the outcomes of EVAR with hostile neck anatomy Methods and Materials Patients demographics ~ patients underwent EVAR for AAA M:F = 56:2 Age : 45~84 yrs (mean: 70.1 yrs) All patients (n=58) were devided two groups according to definition of hostile neck Good neck group : No adverse feature (30/58 pts) Hostile neck group : 1 or more adverse feature (28/58 pts) All medical records and image analysis reviewed retrospectively (n=58) Demographic information Size of aneurysm Neck morphology Diameter, Angulation, Length, Thrombus Primary technical success Intraoperative adjuvant procedure Endoleak Secondary intervention Mortality Statistical analysis Man-Whitney U-test Fisher's exact test Pre procedure imaging CTA (Sensation Cardiac 64 channel, Siemens, Germany) Eurostar registry workstation Post procedure imaging follow up Recommend follow up abdominal CTA after 1week, 1, 3, 6 month Page 2 of 30

3 Results Fig.: Result01 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 3 of 30

4 Fig.: Result02 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 4 of 30

5 Fig.: Result03 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 5 of 30

6 Fig.: Result04 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 6 of 30

7 Fig.: Case1 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 7 of 30

8 Fig.: Case2 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 8 of 30

9 Fig.: Case3 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 9 of 30

10 Fig.: Case3 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 10 of 30

11 Fig.: Case4 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 11 of 30

12 Fig.: Case4 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 12 of 30

13 Fig.: Case4 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 13 of 30

14 Fig.: Case4 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Page 14 of 30

15 Fig.: Case5 References: N.-K. Chang; Department of Radiology, Chonnam National University Hwasun Hospital, Jeollanam-do, KOREA, Republic of Images for this section: Page 15 of 30

16 Fig. 1: Result01 Page 16 of 30

17 Fig. 2: Result02 Page 17 of 30

18 Fig. 3: Result03 Page 18 of 30

19 Fig. 4: Result04 Page 19 of 30

20 Fig. 5: Case1 Page 20 of 30

21 Fig. 6: Case4 Page 21 of 30

22 Fig. 7: Case4 Page 22 of 30

23 Fig. 8: Case4 Page 23 of 30

24 Fig. 9: Case4 Page 24 of 30

25 Fig. 10: Case3 Page 25 of 30

26 Fig. 11: Case3 Page 26 of 30

27 Fig. 12: Case2 Page 27 of 30

28 Fig. 13: Case5 Page 28 of 30

29 Conclusion Our result indicated that AAA with hostile neck anatomy can be successfully treated with EVAR Patients with severe angulated neck may be needed secondary procedure Increasing clinical experience and advance of equipment will expand application of EVAR for hostile neck References 1.Perdikides T, Geogiadis GS, Avgerinos ED, Verilolos C, Hopkinson BR, Lagios K. The aorfix stent -graftto treat infrarenal abdominal aortic aneurysms with angulated necks and/or tortuous iliac arteries: midterm results. J Endovasc Ther 2009;16: Wahlgren CM, Piano G, Desai T, Shaalan W, Bassiouny H,et al. Transperitoneal versus retroperitoneal suprarenal cross-clamping for repair of anbdominal aortic aneurysm with a hostile infrarenal aortic neck. Ann Vasc Surg 2007;21: Wilt TJ, Lederle FA, Macdonald R, Jonk YC, Rector TS, Kane RL. Comparison of endovascular and open surgical repairs for abdominal aortic aneurysm. Evid Rep Technol Assess 2006;144: Cox DE, Jacobs DL, Motaganahalli RL, Wittgen CM, Peterson GJ, et al. Outcomes of endovascular AAA repair in patients with hostile neck anatomy using adjunctive balloon-expandable stents. Vasc Endovascular Surg 2006;40: Hobo R, Kievit J, Leurs LJ, et al. Influence of severe infrarenal aortic neck angulation on complications at the proximal neck following endovascular AAA repair: a EUROSTAR study. J Endovas Ther 2007;14: Verhoeven EL, Prins TR, Tielliu IF, van den Dungen JJ, Zeebregts CJ, Hulsebos RG, et al. Treatment of short-necked infrarenal aortic aneurysms with fenestrated stent-grafts: short-term results. Eur J Vasc Endovasc Surg 2004; 27: May J, White GH, Harris JP, et al. Endovascular repair of abdominal aortic aneurysm in the multifocal atherosclerotic patient. J Cardiovasc Surg 2003;44: David MH, Anthony NH, Thomas KP, Daniel TC, Hyung SK, et al. Endovascular abdominal aortic aneurysm repair in 144 patients: correlation of aneurysm size, proximal aortic neck length, and procedurerelated complications. J Vasc Interv Radiol 2001;12: Edward C, Graham M, Robert M, Anna-Maria B, Ian L, Robert M, et al. Outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile neck anatomy. Cardiovasc Intervent Radiol 2006;29: Chiakof EL, Filinger MF, Matsumura JS, Rutherford RB, et al. Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair. J Vasc S 2002;35: Chiakof EL, Blankensteijn JD, Matsumura JS, Harris PL, White GH, Rutherford RB, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc S 2002;35: Dillvou ED, Page 29 of 30

30 Muluk SC, Rhee RY, Tzeng E, et al. Dose hostile neck anatomy preclude successful endovascular aortic aneurysm repair? J Vasc S 2002;35: Personal Information Page 30 of 30