ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The impact of large proximal aortic neck on endovascular aneurysm repair outcomes
Bahadır Aytekin1, Gökay Deniz1, Ferit Çetinkaya2, Serkan Mola1, Naim Boran Tümer1, Ertekin Utku Ünal3, Ahmet Barış Durukan4, Hakkı Zafer İşcan1
1Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye
2Department of Cardiovascular Surgery, Ağrı Training and Research Hospital, Ağrı, Türkiye
3Department of Cardiovascular Surgery, Ufuk University Medical Faculty, Ankara, Türkiye
4Department of Cardiovascular Surgery, Istinye University Medical Faculty, Istanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2023.25255
Background: This study aims to investigate the effect of large proximal aortic neck diameter on post-endovascular aneurysm repair clinical outcomes.

Methods: A total of 180 patients (168 males, 12 females; mean age: 69.9±7.4 years; range, 46 to 88 years) who underwent elective endovascular aneurysm repair between June 2016 and September 2021 were retrospectively analyzed. According to the proximal infrarenal aortic neck diameter, the patients were divided into two groups: Group 1 (<25 mm; normal aortic neck) and Group 2 (≥25 mm; pre-aneurysmatic aortic neck). Patient characteristics, proximal infrarenal aortic neck diameter measurements with computed tomography angiography, and clinical outcomes were recorded. The primary endpoint was to assess post-endovascular aneurysm repair aortic neck dilatation, mortality, endoleaks, overall survival, type 1a endoleaks-free survival, and eventfree survival regarding the groups.

Results: There was no statistically significant difference in early mortality (p=0.55) and type 1a endoleak incidence between the groups (p=0.55). In Group 1, the mean change in diameter A (proximal infrarenal level) was 2.89±1.74 mm (p=0.01), and it was 2.31±2.1 mm in diameter B (proximal pre-aneurysm-sac level) (p=0.01). The mean change in Group 2 was 2.8±3.4 mm for diameter A (p<0.01) and 2.22±2.3 mm for diameter B (p<0.01). Aortic neck dilatation rates were similar between the groups (p=0.82 for diameter A; p=0.78 for diameter B). The five-year survival, event-free survival, and type 1a endoleak-free survival were also similar (p=0.54, p=0.26, p=0.24, respectively).

Conclusion: Our study results showed that patients with <25 mm and ≥25-mm aortic neck diameters had similar mid-term results and aortic neck dilatation ratio. Endovascular aneurysm repair outcomes can be improved with careful patient and graft selection, and early intervention for complications.

Keywords : Abdominal aortic aneurysm, endoleak, endovascular aneurysm repair
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