ENDOVASCULAR REPAIR OF ANEURYSMS OF THE ABDOMINAL AORTA: PATIENTS WITH HOSTILE ANATOMY OF THE ANEURYSM NECK

Egan Leonidovich Kalmykov^1*Droc Ionel²Georgi Kheladze³Igor Suchkov⁴Rolf Dammrau⁵

• ¹Universitatsklinikum Brandenburg an der Havel GmbH, Brandenburg, Germany
• ²Central Military Hospital, Cardiovascular Surgery, Bucharest, Romania
• ³Tbilisi State Medical University, Tbilisi, Georgia
• ⁴Razanskij gosudarstvennyj medicinskij universitet imeni akademika I P Pavlova, Ryazan, Russia
• ⁵HELIOS Klinikum Siegburg, Siegburg, Germany

Abstract. Introduction. In some cases, endovascular abdominal aortic repair (EVAR) may be hampered by specific anatomical features, the so-called "hostile neck". Aim. To analyse the results after implanting Gore Excluder Conformable endograft prostheses in patients with hostile neck anatomy who had suffered an infrarenal aneurysm. Methods. This is a retrospective, multicentre study, and included 30 patients, who were treated from April 2019 till August 2023. Primary end points were technical success, immediate results with introperative mortality and rate of endoleaks, short-term results with 30-day mortality, complications, endoleaks, migration rate and mid-term follow up. Results. In 29 patients (96%), EVAR was performed as an elective operation and in one patient as emergency treatment. The median age of the patients was 75.0 years [71.0; 79.0], with 83.3% males. The median diameter of the aneurysm was 58.5 mm [55.0;66.0]. The median angle of the neck of the aortic aneurysm was 80.0° [30.0; 90.0], with a median length of 15.0 mm [10.0; 21.0]. Seven of the 30 patients fell outside the standard IFU. The technical success of the procedure was 100%. In three patients, one of the renal arteries was stented using the chimney technique. No type Ia,b endoleak was detected intraoperatively. In one patient, acute thrombosis of the graft was diagnosed after 21 days, and this necessitated graft explantation . The 30-day mortality rate was 3.3%. No endoleaks of types Ia or Ib were identified before discharge from hospital. An endoleak of type II was identified in 4 patients. No local complications were identified. The mean follow-up period was 25,5 [6,0; 36] months. No further intervention was required. No late aortic rupture, endoprosthesis migration, or death was observed subsequently. Conclusion. The use of the Gore Excluder Conformable endoprostheses is an effective method to treat abdominal aortic aneurysms with hostile neck, with good mid-term results, but further research on long-term results is necessary.