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Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy: A Korean Multicenter Retrospective Study

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Abstract

Purpose

We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal® stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle > 60°).

Materials and Methods

We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71 ± 11 years; age range 32–87 years; mean follow-up 50 ± 12 months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan–Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention.

Results

The primary technical success rate (success within 24 h after EVAR) was 100% (24/24). The survival rate was 96 ± 8% at 1 month, 6 months, 1 year, and 3 years, and 87 ± 18% at 5 years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14 days and rhabdomyolysis at 32 months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1 month) (P = 0.001).

Conclusion

Kilt-based EVAR with Seal® stent-grafts for AAAs with a severely angulated neck (angle > 60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.

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References

  1. AbuRahma AF, Campbell J, Stone PA, et al. The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients. J Vasc Surg. 2009;50:738–48.

    Article  PubMed  Google Scholar 

  2. Hobo R, Kievit J, Leurs LJ, Buth J, EUROSTAR Collaborators. Influence of severe infrarenal aortic neck angulation on complications at the proximal neck following endovascular AAA repair: a EUROSTAR study. J Endovasc Ther. 2007;14:1–11.

    Article  PubMed  Google Scholar 

  3. Sternbergh WC 3rd, Carter G, York JW, Yoselevitz M, Money SR. Aortic neck angulation predicts adverse outcome with endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2002;35:482–6.

    Article  PubMed  Google Scholar 

  4. Chaikof EL, Fillinger MF, Matsumura JS, et al. Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair. J Vasc Surg. 2002;35:1061–6.

    Article  PubMed  Google Scholar 

  5. Chisci E, Kristmundsson T, de Donato G, et al. The AAA with a challenging neck: outcome of open versus endovascular repair with standard and fenestrated stent-grafts. J Endovasc Ther. 2009;16:137–46.

    Article  PubMed  Google Scholar 

  6. Jimenez JC, Quinones-Baldrich WJ. Technical modifications for endovascular infrarenal AAA repair for the angulated and dumbbell-shaped neck: the precuff Kilt technique. Ann Vasc Surg. 2011;25:423–30.

    Article  PubMed  Google Scholar 

  7. Minion DJ, Yancey A, Patterson DE, Saha S, Endean ED. The endowedge and kilt techniques to achieve additional juxtarenal seal during deployment of the Gore Excluder endoprosthesis. Ann Vasc Surg. 2006;20:472–7.

    Article  PubMed  Google Scholar 

  8. Albertini JN, Perdikides T, Soong CV, et al. Endovascular repair of abdominal aortic aneurysms in patients with severe angulation of the proximal neck using a flexible stent-graft: European multicenter experience. J Cardiovasc Surg (Torino). 2006;47:245–50.

    CAS  Google Scholar 

  9. Peppelenbosch N, Buth J, Harris PL, et al. Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: does size matter? A report from EUROSTAR. J Vasc Surg. 2004;39:288–97.

    Article  PubMed  Google Scholar 

  10. Greenberg R, Fairman R, Srivastava S, Criado F, Green R. Endovascular grafting in patients with short proximal necks: an analysis of short-term results. Cardiovasc Surg. 2000;8:350–4.

    Article  CAS  PubMed  Google Scholar 

  11. Boult M, Maddern G, Barnes M, Fitridge R. Factors affecting survival after endovascular aneurysm repair: results from a population based audit. Eur J Vasc Endovasc Surg. 2007;34:156–62.

    Article  CAS  PubMed  Google Scholar 

  12. Kim JH, Cho YK, Seo TS, et al. Clinical outcomes for endovascular repair of abdominal aortic aneurysm with the Seal stent graft. J Vasc Surg. 2016;64:1270–7.

    Article  PubMed  Google Scholar 

  13. Jordan WD, Ouriel K, Mehta M, et al. Outcome-based anatomic criteria for defining the hostile aortic neck. J Vasc Surg. 2015;61:1383–90.

    Article  PubMed  Google Scholar 

  14. Welborn MB, McDaniel HB, Johnson RC, et al. Clinical outcome of an extended proximal seal zone with the AFX endovascular aortic aneurysm system. J Vasc Surg. 2014;60:876–84.

    Article  PubMed  Google Scholar 

  15. Chaikof EL, Blankensteijn JD, Harris PL, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg. 2002;35:1048–60.

    Article  PubMed  Google Scholar 

  16. Aronson WL, McAuliffe MS, Miller K. Variability in the American Society of Anesthesiologists Physical Status Classification Scale. AANA J. 2003;71:265–76.

    PubMed  Google Scholar 

  17. Choke E, Munneke G, Morgan R, et al. Outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile neck anatomy. Cardiovasc Intervent Radiol. 2006;29:975–80.

    Article  PubMed  Google Scholar 

  18. Leurs LJ, Stultiëns G, Kievit J. Buth J; EUROSTAR Collaborators. Adverse events at the aneurysmal neck identified at follow-up after endovascular abdominal aortic aneurysm repair: how do they correlate? Vascular. 2005;13:261–7.

    Article  PubMed  Google Scholar 

  19. Dillavou ED, Muluk S, Makaroun MS. Is neck dilatation after endovascular aneurysm repair graft dependent? Results of 4 US Phase II trials. Vasc Endovascular Surg. 2005;39:47–54.

    Article  PubMed  Google Scholar 

  20. Hobo R, Sybrandy JE, Harris PL, Buth J, EUROSTAR Collaborators. Endovascular repair of abdominal aortic aneurysms with concomitant common iliac artery aneurysm: outcome analysis of the EUROSTAR experience. J Endovasc Ther. 2008;15:12–22.

    Article  PubMed  Google Scholar 

  21. Greenberg RK, Sternbergh WC 3rd, Makaroun M, et al. Intermediate results of a United States multicenter trial of fenestrated endograft repair for juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2009;50:730–7.

    Article  PubMed  Google Scholar 

  22. Ghouri MA, Dougherty KG, Krajcer Z. Technical tips for endovascular treatment of abdominal aortic aneurysms with challenging infrarenal neck anatomy using the excluder endoprosthesis. J Endovasc Ther. 2010;17:705–11.

    Article  PubMed  Google Scholar 

  23. Kolvenbach R, Pinter L, Cagiannos C, Veith FJ. Remodeling of the aortic neck with a balloon-expandable stent graft in patients with complicated neck morphology. Vascular. 2008;16:183–8.

    Article  PubMed  Google Scholar 

  24. Sampaio SM, Panneton JM, Mozes G, et al. Aortic neck dilation after endovascular abdominal aortic aneurysm repair: should oversizing be blamed? Ann Vasc Surg. 2006;20:338–45.

    Article  PubMed  Google Scholar 

  25. Malas MB, Jordan WD, Cooper MA, et al. Performance of the Aorfix endograft in severely angulated proximal necks in the PYTHAGORAS United States clinical trial. J Vasc Surg. 2015;62:1108–17.

    Article  PubMed  Google Scholar 

  26. Broos PP, Stokmans RA, van Sterkenburg SM, et al. Performance of the Endurant stent graft in challenging anatomy. J Vasc Surg. 2015;62:312–8.

    Article  PubMed  Google Scholar 

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Acknowledgements

This research was supported by the Central Medical Service Research Fund (Central Medical Service Inc., Seoul, Korea).

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Authors and Affiliations

  1. Department of Radiology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea

    Yong Sun Jeon

  2. Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150 Seongan-ro Gangdong-gu, Seoul, 134-701, Korea

    Young Kwon Cho

  3. Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

    Myung Gyu Song & Tae-Seok Seo

  4. Department of Radiology, Gachon University Gil Hospital, Gachon University College of Medicine, Incheon, Korea

    Jeong Ho Kim

  5. Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea

    Soon-Young Song

  6. Department of Surgery, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea

    Sam Yeol Lee

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  1. Yong Sun Jeon
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  2. Young Kwon Cho
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Correspondence to Young Kwon Cho.

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There are no conflicts of interest to declare.

Ethical Standards

The study design was approved by our institutional review, and the requirement for informed consent was waived due to the study’s retrospective design.

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Jeon, Y.S., Cho, Y.K., Song, M.G. et al. Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy: A Korean Multicenter Retrospective Study. Cardiovasc Intervent Radiol 41, 554–563 (2018). https://doi.org/10.1007/s00270-017-1867-y

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  • DOI: https://doi.org/10.1007/s00270-017-1867-y

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