الفهرس 
Surgical Anatomy of Abdominal AortaOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
A total of 60 patients with one or more unfavorable neck features underwent endovascular aneurysm repair (EVAR) at a single academic center with a commercially available device between December 2016 and December 2018. Available medical records, pre- and postoperative imaging, and clinical follow-up were reviewed.
Mid-term outcome data showed that freedom from endoleak after 1 year of follow-up was reported in 73.52 % of cases. Also, 97.06% of patients showed no sac expansion and 91.76 % of them had no secondary interventions during this period.
This study of EVAR patients in unfavorable proximal neck conditions showed improved early outcomes regarding intraoperative technical feasibility, need for adjunctive procedures, technical success, perioperative major morbidities and mortality, endoleak I rate as compared to previous relevant studies. Mid-term outcomes (sac expansion, endoleak I and reintervention rates) are better to those achieved in patients included in earlier studies.
Based on the current study and experience, we can propose the following protocol for management of different features of unfavorable neck anatomy;
• Wide neck; As most of the current aortic endoprosthesis manufacturers have introduced devices that can cover neck diameter up to 30-32 mm as Zenith®, Endurant™, Excluder®, Incraft®, selection of an appropriate stent graft size with optimum oversizing (10-20%) is enough in these situations.
• Short neck; Ovation® stent graft system is the current graft that is FDA approved to treat short necks ( 10 mm) and provides appealing solution for Unfavorable aneurysm neck features included short neck [<15 mm] (n: 27, 45%), wide neck [>28 mm] (n: 14, 23.33%), angulated neck [>60o] (n: 20, 33.33%), thrombosed neck [ 50% of neck circumference] (n: 16, 26.67%) and conical neck (n:
1, 1.67%). They underwent repair with Zenith® (36.67%), Endurant™ (26.67%),
Incraft® (26.67%) and Excluder® (10%) devices. Technical success was 100% with the aid of intraoperative adjunctive procedures in 23 cases (38.33%). Mean hospital stay 1.83 ± 1.64 days and mean follow-up period 11.93 ± 5.83 months. Perioperative complication rate was 28.33% with early re-intervention needed in 2 cases (3.33%). No perioperative mortality was recorded.