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Jung, Lee, Lee, Lim, Yim, Chang, Kim, Choi, and Jung: Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy
Cardiovascular Radiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2012; 67(5): 323-332.

Published online: 21 November 2012

DOI: https://doi.org/10.0000/jksr.2012.67.5.323

Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

Hye Doo Jung, MD1, Yun Young Lee, MD1, Seung Jin Lee, MD1, Jae Hoon Lim, MD4, Nam Yeol Yim, MD1, Nam Kyu Chang, MD3, Jae Kyu Kim, MD1, Soo Jin Na Choi, MD2, Sang Young Jung, MD2

1Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.

2Department of Vascular Surgery, Chonnam National University Hospital, Gwangju, Korea.

3Department of Radiology, St. Carollo Hospital, Suncheon, Korea.

4Department of Radiology, Donggunsan Hospital, Gunsan, Korea.

Corresponding author: Jae Kyu Kim, MD. Department of Radiology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. Tel. 82-62-220-5746, Fax. 82-62-226-4380, kjkrad@chonnam.ac.kr

Received 8 November 2011       Accepted 29 August 2012

Copyright © 2012 The Korean Society of Radiology

Abstract

Purpose

To evaluate the outcomes and find the prognostic factors of endovascular abdominal aortic aneurysm repair (EVAR) in patients with hostile neck anatomy of the abdominal aorta.

Materials and Methods

This study was performed on 100 patients with abdominal aneurysm who were treated with EVAR between March 2006 and December 2010. We divided the patients into two groups: good neck anatomy (GNA), and hostile neck anatomy (HNA) and then compared the primary success rate and the incidence rate of complications with EVAR between the two groups. Our aim was to determine the factors related to the complications of EVAR among HNA types.

Results

There were no significant differences of primary success rate and incidence rate of complications between the two groups. Among the types of HNA, the short neck angle [odd ratio (OR), 4.23; 95% confidence interval (CI), 1.21-18.70; p = 0.023] and large neck angle (OR, 2.58; 95% CI, 0.15-11.85; p = 0.031) showed a low primary success rate. The short neck angle (OR, 2.32; 95% CI, 1.18-12.29; p = 0.002) and large neck angle (OR, 4.67; 95% CI, 0.14-19.07; p = 0.032) showed a high incidence rate of early type 1 complication. In the case of the large neck angle (OR, 3.78; 95% CI, 0.96-20.80; p = 0.047), the large neck thrombus (OR, 2.23; 95% CI, 0.24-7.12; p = 0.035) and large neck calcification (OR, 2.50; 95% CI, 0.08-18.37; p = 0.043) showed a high incidence rate of complications within a year.

Conclusion

The results suggest that patients with hostile neck anatomy can be treated with EVAR successfully, although there was a higher incidence of complications in patients with a short neck length, severe neck angulation, circumferential thrombosis, and calcified proximal neck.

Keywords: Hostile Neck, Good Neck, Endovascular Abdominal Aortic Aneurysm Repair, Endovascular Aneurysm Repair, EVAR, Aortic Stent

Figures and Tables

Fig. 1
No hostile neck features, a 59-year-old man.
A. Volume rendering image shows infrarenal abdominal aortic aneurysm (sac diameter: 42 mm) with aneurysmal dilatation of left common iliac artery (arrow). There is no adverse feature in the proximal aortic neck.
B. Completion angiogram shows successful deployment of Zenith® 32-118-12 mm.
C. Three months after EVAR, there was no complication on follow up CT image.
Note.-EVAR = endovascular abdominal aortic aneurysm repair
jksr-67-323-g001
Fig. 2
One hostile neck feature, an 84-year-old man.
A. Volume rendering image shows infrarenal abdominal aortic aneurysm (sac diameter: 46 mm) with aneurysmal dilatation of both common iliac arteries. Neck angulation is 84°.
B. Completion angiogram shows no immediate complication after deployment of Zenith® 28-133-12 mm.
C. Six months after EVAR, there was no complication on follow up abdomen CTA.
Note.-CTA = CT angiography, EVAR = endovascular abdominal aortic aneurysm repair
jksr-67-323-g002
Fig. 3
Two hostile neck features, an 85-year-old man.
A. Volume rendering image shows infrarenal abdominal aortic aneurysm (sac diameter: 48 mm) with calcified proximal neck and conical neck.
B. Follow up angiogram shows Type Ia endoleak (arrow) after deployment of Zenith® 30-155 mm.
C. After deployment of aortic ring (14-90 mm), type Ia endoleak was improved.
D. After 1 month, there was no complication on follow up abdomen CTA.
Note.-CTA = CT angiography
jksr-67-323-g003
Table 1
Hostile Neck Features
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Table 2
Demographics by Neck Anatomy
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Note.-*p-value < 0.05: significant difference.

†Data are presented as mean ± SEM.

GNA = good neck anatomy, HNA = hostile neck anatomy

Table 3
Abdominal Aortic Aneurysm Characteristics by Neck Anatomy
jksr-67-323-i003

Note.-*Increased sac diameter > 5 mm.

*Decreased sac diameter > 5 mm.

AAA = abdominal aortic aneurysm, GNA = good neck anatomy, HNA = hostile neck anatomy

Table 4
Endoleak and Intervention by Neck Anatomy
jksr-67-323-i004

Note.-*Successful introduction and deployment of stents in the absence of surgical conversion or mortality, type I or III endoleak.

†Primary technical success after unplanned stent deployment for treatment of endoleak.

‡Late endoleak: New onset of endoleak after 30 days.

GNA = good neck anatomy, HNA = hostile neck anatomy

Table 5
Logistic Regression Analysis by Hostile Neck Features
jksr-67-323-i005

Note.-CI = confidence interval, OR = odd ratio

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