Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck

Sergey Furkalo; Inna Khasyanova; Andriy Khokhlov

doi:doi:10.11648/j.ajim.20221003.11

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Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck

Sergey Furkalo, Inna Khasyanova, Andriy Khokhlov

Published in American Journal of Internal Medicine (Volume 10, Issue 3)

Received: 12 February 2022 Accepted: 25 April 2022 Published: 10 May 2022

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Abstract

About 40% of patients with AAA, due to the anatomical characteristics of the aorta, cannot be candidates for EVAR. Anatomical features that are difficult or unacceptable for stent-graft placement include short or no proximal neck, angular, tapered neck, and vessel diameter that exceeds the existing capabilities of endoprostheses. In patients where traditional surgical correction is not an acceptable option, various technological methods and equipment are used. The observation included 18 consecutive patients with AAA, where EVAR was performed. When analyzing the anatomical characteristics of the aneurysmal sac, 9 (50%) patients were classified as patients with an unfavorable proximal neck of the aneurysm, the so-called “hostile neck”. 4 EVAR interventions were complex (2 patients with parallel grafts), which made it possible to achieve an increase in the proximal infrarenal zone implantation up to 16-20 mm, and supplemented or additional endovascular procedures - in our case, implantation of “Aptus Heli-FX” endoancors in 5 patients. The comparison group consisted of 9 patients with a standard aneurysm neck, where standard EVAR procedures were performed. The main anatomical difference in the groups was the length of the aneurysm neck - 9.8 mm and 36.1 mm in groups I and II, respectively (p - 0,0003). EVAR in the groups were carried out without significant complications and operation death; in the first group, the duration of the operation (p-0,01), the amount of contrast (p-0,03) and the fluoro time (p - 0,01) were significantly increased than in the patients of group II. The postoperative period did not differ between the groups. So the use of modern technological methods allows to significantly expand the indications for EVAR in patients with unfavorable anatomy.

Published in	American Journal of Internal Medicine (Volume 10, Issue 3)
DOI	10.11648/j.ajim.20221003.11
Page(s)	34-38
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Abdominal Aortic Aneurism, Endovascular Repair, Hostile Aneurismal Neck, Chimney, Enndoanchors

References

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[2]	Enrico Gallitto, Mauro Gargiulo, Antonio Freyrie, Chiara Mascoli, Claudio Massoni Bianchini, Stefano Ancetti, Gianluca Faggioli, Andrea Stella. The endovascular treatment of juxta-renal abdominal aortic aneurysm using fenestrated endograft: early and mid-term results. J. Cardiovascular Surgery 2019 Apr; 60 (2): 237-244. doi: 10.23736/S0021-9509.16.09049-2.
[3]	Verhoeven EL, Vourliotakis G, Bos WT, Tielliu IF, Zeebregts CJ, Prins TR, et al. Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: an 8-year single-centre experience. Eur J Vasc Endovasc Surg 2010; 39: 529-36. https://doi.org/10.1016/j.ejvs.2010.01.004
[4]	Furkalo S. N., Khokhlov A. V. The first experience of clinical application of mechanical fixation devices "Aptus Heli-FX" during endovascular prosthetics of the abdominal part of the aorta. Klinichna hirurgiya 2019, vol. 86, N 3, pp. 71-73. Clinical surgery 2019, v. 86, N 3, p. 71-73.
[5]	De Vries JP, Van De Pavoordt HD, Jordan WD Jr. Rationale of Endo Anchors in abdominal aortic aneurysms with short or angulated necks. J Cardiovasc Surg (Torino). 2014 Feb; 55 (1): 103-7. PMID: 24356052.
[6]	Goudeketting SR, van Noort K, Ouriel K, Jordan WD Jr, Panneton JM, Slump CH, de Vries JPM. Influence of aortic neck characteristics on successful aortic wall penetration of EndoAnchors in therapeutic use during endovascular aneurysm repair. J Vasc Surg. 2018 Oct; 68 (4): 1007-1016. doi: 10.1016/j.jvs.2018.01.039.
[7]	Pitoulias GA, Valdivia AR, Hahtapornsawan S, Torsello G, Pitoulias AG, Austermann M, Gandarias C, Donas KP. Conical neck is strongly associated with proximal failure in standard endovascular aneurysm repair.. J Vasc Surg. 2017 Dec; 66 (6): 1686-1695. doi: 10.1016/j.jvs.2017.03.440.
[8]	Hiramoto JS, Chang CK, Reilly LM, Schneider DB, Rapp JH, Chuter TA. Outcome of renal stenting for renal artery coverage during endovascular aortic aneurysm repair. J Vasc Surg 2009; 49: 1100-6. DOI: 10.1016/j.jvs.2008.11.060.
[9]	Donas, Konstantinos P.; Lee, Jason T.; Lachat, Mario MD; Torsello, Giovanni; Veith, Frank J. on behalf of the PERICLES investigators. Collected World Experience About the Performance of the Snorkel/Chimney Endovascular Technique in the Treatment of Complex Aortic Pathologies. The PERICLES Registry Annals of Surgery: September 2015 - Volume 262 - Issue 3 - p 546-553. doi: 10.1097/SLA.0000000000001405.
[10]	William D Jordan Jr 1, Manish Mehta 2, Kenneth Ouriel 3, Frank R Arko 4, David Varnagy 5, James Joye 6, William M Moore Jr 7, Jean-Paul P M de Vries. One-year results of the ANCHOR trial of EndoAnchors for the prevention and treatment of aortic neck complications after endovascular aneurysm repair. Vascular. 2016 Apr; 24 (2): 177-86. doi: 10.1177/1708538115590727.
[11]	Georgios Karaolanis, Constantine N Antonopoulos, Stylianos Koutsias, George A Antoniou, Efthymios Beropoulis, Giovanni Torsello, Gergana T Taneva, Konstantinos P Donas. Outcomes of endosutured aneurysm repair with the Heli-FX Endo Anchor implants. Vascular. 2020 May 9; 1708538120923417. doi: 10.1177/1708538120923417. Online ahead of print.

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APA Style

Sergey Furkalo, Inna Khasyanova, Andriy Khokhlov. (2022). Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck. American Journal of Internal Medicine, 10(3), 34-38. https://doi.org/10.11648/j.ajim.20221003.11

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ACS Style

Sergey Furkalo; Inna Khasyanova; Andriy Khokhlov. Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck. Am. J. Intern. Med. 2022, 10(3), 34-38. doi: 10.11648/j.ajim.20221003.11

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AMA Style

Sergey Furkalo, Inna Khasyanova, Andriy Khokhlov. Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck. Am J Intern Med. 2022;10(3):34-38. doi: 10.11648/j.ajim.20221003.11

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@article{10.11648/j.ajim.20221003.11,
  author = {Sergey Furkalo and Inna Khasyanova and Andriy Khokhlov},
  title = {Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck},
  journal = {American Journal of Internal Medicine},
  volume = {10},
  number = {3},
  pages = {34-38},
  doi = {10.11648/j.ajim.20221003.11},
  url = {https://doi.org/10.11648/j.ajim.20221003.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20221003.11},
  abstract = {About 40% of patients with AAA, due to the anatomical characteristics of the aorta, cannot be candidates for EVAR. Anatomical features that are difficult or unacceptable for stent-graft placement include short or no proximal neck, angular, tapered neck, and vessel diameter that exceeds the existing capabilities of endoprostheses. In patients where traditional surgical correction is not an acceptable option, various technological methods and equipment are used. The observation included 18 consecutive patients with AAA, where EVAR was performed. When analyzing the anatomical characteristics of the aneurysmal sac, 9 (50%) patients were classified as patients with an unfavorable proximal neck of the aneurysm, the so-called “hostile neck”. 4 EVAR interventions were complex (2 patients with parallel grafts), which made it possible to achieve an increase in the proximal infrarenal zone implantation up to 16-20 mm, and supplemented or additional endovascular procedures - in our case, implantation of “Aptus Heli-FX” endoancors in 5 patients. The comparison group consisted of 9 patients with a standard aneurysm neck, where standard EVAR procedures were performed. The main anatomical difference in the groups was the length of the aneurysm neck - 9.8 mm and 36.1 mm in groups I and II, respectively (p - 0,0003). EVAR in the groups were carried out without significant complications and operation death; in the first group, the duration of the operation (p-0,01), the amount of contrast (p-0,03) and the fluoro time (p - 0,01) were significantly increased than in the patients of group II. The postoperative period did not differ between the groups. So the use of modern technological methods allows to significantly expand the indications for EVAR in patients with unfavorable anatomy.},
 year = {2022}
}

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TY  - JOUR
T1  - Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck
AU  - Sergey Furkalo
AU  - Inna Khasyanova
AU  - Andriy Khokhlov
Y1  - 2022/05/10
PY  - 2022
N1  - https://doi.org/10.11648/j.ajim.20221003.11
DO  - 10.11648/j.ajim.20221003.11
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 34
EP  - 38
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20221003.11
AB  - About 40% of patients with AAA, due to the anatomical characteristics of the aorta, cannot be candidates for EVAR. Anatomical features that are difficult or unacceptable for stent-graft placement include short or no proximal neck, angular, tapered neck, and vessel diameter that exceeds the existing capabilities of endoprostheses. In patients where traditional surgical correction is not an acceptable option, various technological methods and equipment are used. The observation included 18 consecutive patients with AAA, where EVAR was performed. When analyzing the anatomical characteristics of the aneurysmal sac, 9 (50%) patients were classified as patients with an unfavorable proximal neck of the aneurysm, the so-called “hostile neck”. 4 EVAR interventions were complex (2 patients with parallel grafts), which made it possible to achieve an increase in the proximal infrarenal zone implantation up to 16-20 mm, and supplemented or additional endovascular procedures - in our case, implantation of “Aptus Heli-FX” endoancors in 5 patients. The comparison group consisted of 9 patients with a standard aneurysm neck, where standard EVAR procedures were performed. The main anatomical difference in the groups was the length of the aneurysm neck - 9.8 mm and 36.1 mm in groups I and II, respectively (p - 0,0003). EVAR in the groups were carried out without significant complications and operation death; in the first group, the duration of the operation (p-0,01), the amount of contrast (p-0,03) and the fluoro time (p - 0,01) were significantly increased than in the patients of group II. The postoperative period did not differ between the groups. So the use of modern technological methods allows to significantly expand the indications for EVAR in patients with unfavorable anatomy.
VL  - 10
IS  - 3
ER  -

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Author Information

Sergey Furkalo

Endovascular & Interventional Radiology Department, National Institute of Surgery and Transplantology Named After Shalimov A. A., Kiev, Ukraine
Inna Khasyanova

Endovascular & Interventional Radiology Department, National Institute of Surgery and Transplantology Named After Shalimov A. A., Kiev, Ukraine
Andriy Khokhlov

Endovascular Surgery and Angiography Department, Heart Institute, Ministry of Health of Ukraine, Kiev, Ukraine

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APA Style

Sergey Furkalo, Inna Khasyanova, Andriy Khokhlov. (2022). Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck. American Journal of Internal Medicine, 10(3), 34-38. https://doi.org/10.11648/j.ajim.20221003.11

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ACS Style

Sergey Furkalo; Inna Khasyanova; Andriy Khokhlov. Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck. Am. J. Intern. Med. 2022, 10(3), 34-38. doi: 10.11648/j.ajim.20221003.11

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AMA Style

Sergey Furkalo, Inna Khasyanova, Andriy Khokhlov. Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck. Am J Intern Med. 2022;10(3):34-38. doi: 10.11648/j.ajim.20221003.11

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@article{10.11648/j.ajim.20221003.11,
  author = {Sergey Furkalo and Inna Khasyanova and Andriy Khokhlov},
  title = {Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck},
  journal = {American Journal of Internal Medicine},
  volume = {10},
  number = {3},
  pages = {34-38},
  doi = {10.11648/j.ajim.20221003.11},
  url = {https://doi.org/10.11648/j.ajim.20221003.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20221003.11},
  abstract = {About 40% of patients with AAA, due to the anatomical characteristics of the aorta, cannot be candidates for EVAR. Anatomical features that are difficult or unacceptable for stent-graft placement include short or no proximal neck, angular, tapered neck, and vessel diameter that exceeds the existing capabilities of endoprostheses. In patients where traditional surgical correction is not an acceptable option, various technological methods and equipment are used. The observation included 18 consecutive patients with AAA, where EVAR was performed. When analyzing the anatomical characteristics of the aneurysmal sac, 9 (50%) patients were classified as patients with an unfavorable proximal neck of the aneurysm, the so-called “hostile neck”. 4 EVAR interventions were complex (2 patients with parallel grafts), which made it possible to achieve an increase in the proximal infrarenal zone implantation up to 16-20 mm, and supplemented or additional endovascular procedures - in our case, implantation of “Aptus Heli-FX” endoancors in 5 patients. The comparison group consisted of 9 patients with a standard aneurysm neck, where standard EVAR procedures were performed. The main anatomical difference in the groups was the length of the aneurysm neck - 9.8 mm and 36.1 mm in groups I and II, respectively (p - 0,0003). EVAR in the groups were carried out without significant complications and operation death; in the first group, the duration of the operation (p-0,01), the amount of contrast (p-0,03) and the fluoro time (p - 0,01) were significantly increased than in the patients of group II. The postoperative period did not differ between the groups. So the use of modern technological methods allows to significantly expand the indications for EVAR in patients with unfavorable anatomy.},
 year = {2022}
}

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TY  - JOUR
T1  - Evar Acute Results in Patients with Hostile Proximal Aneurysmal Neck
AU  - Sergey Furkalo
AU  - Inna Khasyanova
AU  - Andriy Khokhlov
Y1  - 2022/05/10
PY  - 2022
N1  - https://doi.org/10.11648/j.ajim.20221003.11
DO  - 10.11648/j.ajim.20221003.11
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 34
EP  - 38
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20221003.11
AB  - About 40% of patients with AAA, due to the anatomical characteristics of the aorta, cannot be candidates for EVAR. Anatomical features that are difficult or unacceptable for stent-graft placement include short or no proximal neck, angular, tapered neck, and vessel diameter that exceeds the existing capabilities of endoprostheses. In patients where traditional surgical correction is not an acceptable option, various technological methods and equipment are used. The observation included 18 consecutive patients with AAA, where EVAR was performed. When analyzing the anatomical characteristics of the aneurysmal sac, 9 (50%) patients were classified as patients with an unfavorable proximal neck of the aneurysm, the so-called “hostile neck”. 4 EVAR interventions were complex (2 patients with parallel grafts), which made it possible to achieve an increase in the proximal infrarenal zone implantation up to 16-20 mm, and supplemented or additional endovascular procedures - in our case, implantation of “Aptus Heli-FX” endoancors in 5 patients. The comparison group consisted of 9 patients with a standard aneurysm neck, where standard EVAR procedures were performed. The main anatomical difference in the groups was the length of the aneurysm neck - 9.8 mm and 36.1 mm in groups I and II, respectively (p - 0,0003). EVAR in the groups were carried out without significant complications and operation death; in the first group, the duration of the operation (p-0,01), the amount of contrast (p-0,03) and the fluoro time (p - 0,01) were significantly increased than in the patients of group II. The postoperative period did not differ between the groups. So the use of modern technological methods allows to significantly expand the indications for EVAR in patients with unfavorable anatomy.
VL  - 10
IS  - 3
ER  -

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