P-014 - LATE NECK RELATED ADVERSE EVENTS ARE RARE AMONG PATIENTS WITH WIDE AORTIC NECK UNDERGOING ENDOVASCULAR ANEURYSM REPAIR WITH THE OVATION ENDOGRAFT

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Kontopodis N. (Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete. ~ Herakion, Crete ~ Greece) , Charalambous S. (Department of Radiology, Division of Interventional Radiology, Nicosia General Hospital, Nicosia, Cyprus ~ Nicosia ~ Cyprus) , Lioudaki S. (Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete. ~ Herakion, Crete ~ Greece) , Tavlas E. (Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete. ~ Herakion, Crete ~ Greece) , Galanakis N. (Interventional Radiology Unit, Department of Medical Imaging, Medical School, University of Crete. ~ Heraklion, Crete ~ Greece) , Tzartzalou I. (Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete. ~ Herakion, Crete ~ Greece) , Kehagias E. (Interventional Radiology Unit, Department of Medical Imaging, Medical School, University of Crete. ~ Heraklion, Crete ~ Greece) , Ioannou C. (Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete. ~ Herakion, Crete ~ Greece)
Introduction:
Patients with wide aortic necks undergoing Endovascular Aneurysm Repair (EVAR) have been shown to be at a higher risk for neck-related complications. We aim to examine outcomes of EVAR with an endograft exerting minimal outward pressure (Ovation-Endologix) in patients with a large baseline neck diameter.
Methods:
We performed a retrospective single center study, including consecutive patients undergoing EVAR with the Ovation system from 05/2011 to 04/2021. Patients were divided in Groups 1 and 2 if the 20,23,26,29mm or the 34mm proximal diameter main body was used, respectively. According to the instructions for use of the device, for neck diameters 27-30mm the 34mm main body is required. Primary endpoint was rate of neck related complications during follow-up, (type Ia endoleak, migration >10mm and neck-related re-interventions). Secondary endpoints were peri-procedural and follow-up outcomes such as endoleaks, reinterventions and overall mortality. Multiple aortic neck diameters were recorded and compared between the 1-month computed tomography angiography (CTA) after EVAR and the last available follow-up CTA to determine rates of aortic neck dilatation (AND).
Results:
In total 281 patients were included, 222 in Group 1 and 59 in Group 2. Patients in Group 2 presented significantly shorter neck length, higher neck angulation and more common reversed tapered configuration. Median follow-up was 36 months (Range:6-106). Early and late type Ia endoleak was observed in 4 and 2 patients in each group, respectively (P=0.063 and P=0.195, respectively). Distal migration was observed in 2 patients in Group 2 and AND was recorded in 2 patients in each group. Freedom from the primary endpoint was estimated at 98%, 94%, 94% at 12-, 36-, 60-months for Group 1 and at 98%, 95%, 86% for Group 2 (P-Value 0.266) (Figure 1). Probability of survival was 95%, 86%, 75% at 12-, 36-, 60-months for Group 1 and 83%, 77%, 72% for Group 2 (P-Value 0.226).Multivariate regression analysis identified neither Group 1 vs Group 2 nor absolute value of aortic neck diameter as significant predictors of neck-related adverse events. Neck diameters did not display significant differences over time in any of the levels evaluated.
Conclusion:
EVAR with the Ovation endograft results in low rates of late neck related complications which is also true for patients with wide baseline aortic necks.
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