MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES

Detalhes bibliográficos
Autor(a) principal: Oliveira-Pinto, José
Data de Publicação: 2020
Outros Autores: Ferreira, Rita Soares, Oliveira, Nélson F. G., Gonçalves, Frederico Bastos, Hoeks, Sanne, Van Rijn, Marie Josee, Ten Raa, Sander, Mansilha, Armando, Verhagen, Hence
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://doi.org/10.48750/acv.297
Resumo: Introduction: Endovascular aneurysm repair (EVAR) became the preferred modality for infrarenal aneurysm (AAA) repair. Several available endografts have main body proximal diameters up to 36mm, allowing for treatment of proximal AAA necks up to 32 mm. However, large neck represents a predictor of proximal complications after EVAR. The purpose of this study is to evaluate mid-term outcomes of patients requiring 34-36mm main body devices. Methods: Retrospective review of a prospectively maintained database including all patients undergoing elective EVAR for degenerative AAA in a single tertiary referral hospital in The Netherlands were eligible. All measurements were performed on center-lumen line reconstructions obtained on dedicated software. Patients were classified as large diameter (LD) if the implanted device was >32mm wide. The remaining patients were classified as normal diameter (ND). Primary endpoint was neck-related events (a composite of “endoleak” (EL) 1A, neck-related secondary intervention or migration >5mm). Neck morphology changes and survival were also assessed. Differences in groups were adjusted by multivariable analysis. Results: The study included 502 patients (90 in the LD group; 412 in the ND group). Median follow-up was 3.5 years (1.5–6.2) and 4.5 years (2.1–7.3) for the LD and ND groups, respectively (P = .008). Regarding baseline characteristics, hypertension (83% vs 69.7%, P=.012) and smoking (86% vs 74.1%, P=.018) were more frequent in the LD group. Patients in the LD group had wider (Proximal neck Ø > 28 mm: 75% vs 3.3%, P<.001), more angulated (α-angle>45º: 21% vs 9%, P=.002), more conical (39.8% vs 20.3%, P<.001) and a thrombus-laden neck (Neck thrombus >25%: 42% vs 32.3%, P<.089). Oversizing was greater among LD group (20% [12.5–28.8] vs 16.7% [12–21.7], P=.008). All other anatomical risk factors were similar between groups. The 5-year freedom from neck-related event was 73% for the LD group and 85% for the ND group, P=.001. Type 1A endoleaks were more common in the LD group (12.2% vs 5.1%, P=.003). Migration > 5mm occurred similarly in both groups (7.8% vs 5.1%, P=.32). Neck-related secondary interventions were also more common among LD patients (13.3% vs 8.7%; P = .027). On multivariable regression analysis, LD group was an independent risk factor for neck-related adverse events (Hazard Ratio [HR]: 2.29; 95% confidence interval [CI], 1.37–3.83, P=0.002). Neck dilatation was greater among LD patients (median, 3 mm [IQR, 0–6] vs 2mm [IQR, 0–4]; P =.034) On multivariable analysis, LD was an independent predictor for neck dilatation > 10 % (HR: 1.61 CI 95% 1.08–2.39, P=.020). Survival at 5-years was 66.1% for LD and 71.2% for SD groups, P=.14. Conclusion: Standard EVAR in patients with large infrarenal necks requiring a 34- to 36-mm proximal endograft is independently associated to increased rate of neck related events and more neck dilatation. This subgroup of patients could be considered for more proximal seal strategies with fenestrated or branched devices, if unfit for open repair. Tighter surveillance following EVAR in these patients in the long term is also advised.
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spelling MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICESALTERAÇÕES MORFOLÓGICAS E CONSEQUÊNCIAS CLÍNICAS DO TRATAMENTO DE COLOS PROXIMAIS LARGOS REQUERENDO ENDOPRÓTESES COM 34-36MM DE DIÂMETROAortic aneurysmAbdominal (MeSH)AneurysmAortic neckNeck DiameterNeck-related eventsAneurisma da Aorta abdominalColo aneurismáticoDiâmetro do coloEventos relacionados com o coloIntroduction: Endovascular aneurysm repair (EVAR) became the preferred modality for infrarenal aneurysm (AAA) repair. Several available endografts have main body proximal diameters up to 36mm, allowing for treatment of proximal AAA necks up to 32 mm. However, large neck represents a predictor of proximal complications after EVAR. The purpose of this study is to evaluate mid-term outcomes of patients requiring 34-36mm main body devices. Methods: Retrospective review of a prospectively maintained database including all patients undergoing elective EVAR for degenerative AAA in a single tertiary referral hospital in The Netherlands were eligible. All measurements were performed on center-lumen line reconstructions obtained on dedicated software. Patients were classified as large diameter (LD) if the implanted device was >32mm wide. The remaining patients were classified as normal diameter (ND). Primary endpoint was neck-related events (a composite of “endoleak” (EL) 1A, neck-related secondary intervention or migration >5mm). Neck morphology changes and survival were also assessed. Differences in groups were adjusted by multivariable analysis. Results: The study included 502 patients (90 in the LD group; 412 in the ND group). Median follow-up was 3.5 years (1.5–6.2) and 4.5 years (2.1–7.3) for the LD and ND groups, respectively (P = .008). Regarding baseline characteristics, hypertension (83% vs 69.7%, P=.012) and smoking (86% vs 74.1%, P=.018) were more frequent in the LD group. Patients in the LD group had wider (Proximal neck Ø > 28 mm: 75% vs 3.3%, P<.001), more angulated (α-angle>45º: 21% vs 9%, P=.002), more conical (39.8% vs 20.3%, P<.001) and a thrombus-laden neck (Neck thrombus >25%: 42% vs 32.3%, P<.089). Oversizing was greater among LD group (20% [12.5–28.8] vs 16.7% [12–21.7], P=.008). All other anatomical risk factors were similar between groups. The 5-year freedom from neck-related event was 73% for the LD group and 85% for the ND group, P=.001. Type 1A endoleaks were more common in the LD group (12.2% vs 5.1%, P=.003). Migration > 5mm occurred similarly in both groups (7.8% vs 5.1%, P=.32). Neck-related secondary interventions were also more common among LD patients (13.3% vs 8.7%; P = .027). On multivariable regression analysis, LD group was an independent risk factor for neck-related adverse events (Hazard Ratio [HR]: 2.29; 95% confidence interval [CI], 1.37–3.83, P=0.002). Neck dilatation was greater among LD patients (median, 3 mm [IQR, 0–6] vs 2mm [IQR, 0–4]; P =.034) On multivariable analysis, LD was an independent predictor for neck dilatation > 10 % (HR: 1.61 CI 95% 1.08–2.39, P=.020). Survival at 5-years was 66.1% for LD and 71.2% for SD groups, P=.14. Conclusion: Standard EVAR in patients with large infrarenal necks requiring a 34- to 36-mm proximal endograft is independently associated to increased rate of neck related events and more neck dilatation. This subgroup of patients could be considered for more proximal seal strategies with fenestrated or branched devices, if unfit for open repair. Tighter surveillance following EVAR in these patients in the long term is also advised.Introdução: O tratamento endovascular representa o método de eleição para o tratamento de Aneurismas da Aorta Abdominal (AAA). Existem endopróteses disponíveis com diâmetros do colo proximal até 36mm, que permitem o tratamento de colos proximais até 32 mm. Contudo, a existência de colos largos representa um conhecido preditor de complicações. O objetivo deste estudo é avaliar os resultados a médio-prazo de doentes que requereram endopróteses de 34-36mm. Métodos: Foi realizada uma análise retrospetiva de uma base de dados prospetiva, incluindo todos os pacientes submetidos a EVAR por AAA degenerativo numa instituição terciária na Holanda. Todas as medições foram realizadas em reconstruções center-lumen line em software dedicado. Os pacientes foram classificados como “diâmetro largo” (LD), se a endoprótese implantada tivesse diâmetro superior a 32 mm.. Os restantes pacientes foram classificados como diâmetro normal (ND). O endpoint primário foi complicações relacionadas com o colo (combinação de endoleak tipo IA, migração>5mm ou qualquer intervenção no colo proximal). Alterações morfológicas no colo e sobrevida foram também analisadas. Diferenças entre grupos foram ajustadas por regressão multivariável. Resultados: O estudo incluiu 502 pacientes (90 no grupo LD e 412 no grupo ND). O follow-up mediano foi de 3.5 anos IQR (1.5–6.2) e 4.5 anos IQR (2.1–7.3) para os grupos LD e ND, respetivamente, P=.008. Relativamente às características basais, os doentes no grupo LD, apresentavam maior incidência de hipertensão arterial (83% vs 69.7%, P=.012) e tabagismo (86% vs 84.1%, P=.018). Além de colos mais largos (colo Proximal Ø > 28 mm: 75% vs 3.3%, P<.001), os indivíduos do grupo LD apresentavam também colos mais angulados (ângulo-α >45º: 21% vs 9%, P=.002), cónicos (39.8% vs 20.3%, P<.001) e com maior proporção de trombo circunferencial (Trombo no colo >25%: 42% vs 32.3%, P<.089). O oversizing foi maior entre o grupo LD (20% [12.5–28.8] vs 16.7% [12–21.7], P=.008). Todas os restantes detalhes anatómicos eram semelhantes entre grupos. A ausência de complicações relacionadas com o colo aos 5 anos foi de 73% no grupo LD e de 85% no grupo ND, P=.001. Endoleak tipo 1A foi mais comum no grupo LD (12.2% vs 5.1%, P=.003). Migração>5 mm ocorreu similarmente entre grupos (7.8% vs 5.1%, P=.32). Reintervenções relacionadas com colo o foram também mais frequentes no grupo LD (13.3% vs 8.7%, P=.027). Na análise multivariável, o grupo LD representou um fator de risco independente para complicações relacionadas com o colo (Hazard Ratio [HR]: 2.29; Intervalo de Confiança [IC] a 95%, 1.37–3.83, P=0.002). A dilatação do colo foi mais proeminente no grupo LD (3mm IQR [0–6] vs 2mm IQR [0–4], P=.034). Em análise multivariável, o grupo LD representava um preditor independente de dilatação do colo acima de 10% (HR:1.61 IC95% 1.08–2.39, P=.020). A sobrevida aos 5 anos foi de 66.1% no grupo LD e 71.2% no grupo SD, P=.14. Conclusão: O EVAR standard em pacientes com colos infra-renais requerendo endopróteses com diâmetro 34-36mm está independentemente associada a maior risco de complicações relacionadas com o colo e maior grau de dilatação do colo. Este subgrupo deverá ser considerado para estratégias de selagem proximal mais eficazes como endopróteses fenestradas, se a correção aberta não constituir opção. Follow-up mais intensivo deve ser adotado se EVAR padrão for a opção preconizada.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2020-08-05T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.297oai:ojs.acvjournal.com:article/297Angiologia e Cirurgia Vascular; Vol. 16 No. 2 (2020): June; 61-70Angiologia e Cirurgia Vascular; Vol. 16 N.º 2 (2020): Junho; 61-702183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/297https://doi.org/10.48750/acv.297http://acvjournal.com/index.php/acv/article/view/297/178Copyright (c) 2020 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessOliveira-Pinto, JoséFerreira, Rita SoaresOliveira, Nélson F. G.Gonçalves, Frederico BastosHoeks, SanneVan Rijn, Marie JoseeTen Raa, SanderMansilha, ArmandoVerhagen, Hence2022-05-23T15:10:09Zoai:ojs.acvjournal.com:article/297Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:39.981281Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES
ALTERAÇÕES MORFOLÓGICAS E CONSEQUÊNCIAS CLÍNICAS DO TRATAMENTO DE COLOS PROXIMAIS LARGOS REQUERENDO ENDOPRÓTESES COM 34-36MM DE DIÂMETRO
title MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES
spellingShingle MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES
Oliveira-Pinto, José
Aortic aneurysm
Abdominal (MeSH)
Aneurysm
Aortic neck
Neck Diameter
Neck-related events
Aneurisma da Aorta abdominal
Colo aneurismático
Diâmetro do colo
Eventos relacionados com o colo
title_short MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES
title_full MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES
title_fullStr MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES
title_full_unstemmed MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES
title_sort MORPHOLOGIC CHANGES AND CLINICAL CONSEQUENCES OF WIDE AAA NECKS TREATED WITH 34-36MM PROXIMAL DIAMETER EVAR DEVICES
author Oliveira-Pinto, José
author_facet Oliveira-Pinto, José
Ferreira, Rita Soares
Oliveira, Nélson F. G.
Gonçalves, Frederico Bastos
Hoeks, Sanne
Van Rijn, Marie Josee
Ten Raa, Sander
Mansilha, Armando
Verhagen, Hence
author_role author
author2 Ferreira, Rita Soares
Oliveira, Nélson F. G.
Gonçalves, Frederico Bastos
Hoeks, Sanne
Van Rijn, Marie Josee
Ten Raa, Sander
Mansilha, Armando
Verhagen, Hence
author2_role author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Oliveira-Pinto, José
Ferreira, Rita Soares
Oliveira, Nélson F. G.
Gonçalves, Frederico Bastos
Hoeks, Sanne
Van Rijn, Marie Josee
Ten Raa, Sander
Mansilha, Armando
Verhagen, Hence
dc.subject.por.fl_str_mv Aortic aneurysm
Abdominal (MeSH)
Aneurysm
Aortic neck
Neck Diameter
Neck-related events
Aneurisma da Aorta abdominal
Colo aneurismático
Diâmetro do colo
Eventos relacionados com o colo
topic Aortic aneurysm
Abdominal (MeSH)
Aneurysm
Aortic neck
Neck Diameter
Neck-related events
Aneurisma da Aorta abdominal
Colo aneurismático
Diâmetro do colo
Eventos relacionados com o colo
description Introduction: Endovascular aneurysm repair (EVAR) became the preferred modality for infrarenal aneurysm (AAA) repair. Several available endografts have main body proximal diameters up to 36mm, allowing for treatment of proximal AAA necks up to 32 mm. However, large neck represents a predictor of proximal complications after EVAR. The purpose of this study is to evaluate mid-term outcomes of patients requiring 34-36mm main body devices. Methods: Retrospective review of a prospectively maintained database including all patients undergoing elective EVAR for degenerative AAA in a single tertiary referral hospital in The Netherlands were eligible. All measurements were performed on center-lumen line reconstructions obtained on dedicated software. Patients were classified as large diameter (LD) if the implanted device was >32mm wide. The remaining patients were classified as normal diameter (ND). Primary endpoint was neck-related events (a composite of “endoleak” (EL) 1A, neck-related secondary intervention or migration >5mm). Neck morphology changes and survival were also assessed. Differences in groups were adjusted by multivariable analysis. Results: The study included 502 patients (90 in the LD group; 412 in the ND group). Median follow-up was 3.5 years (1.5–6.2) and 4.5 years (2.1–7.3) for the LD and ND groups, respectively (P = .008). Regarding baseline characteristics, hypertension (83% vs 69.7%, P=.012) and smoking (86% vs 74.1%, P=.018) were more frequent in the LD group. Patients in the LD group had wider (Proximal neck Ø > 28 mm: 75% vs 3.3%, P<.001), more angulated (α-angle>45º: 21% vs 9%, P=.002), more conical (39.8% vs 20.3%, P<.001) and a thrombus-laden neck (Neck thrombus >25%: 42% vs 32.3%, P<.089). Oversizing was greater among LD group (20% [12.5–28.8] vs 16.7% [12–21.7], P=.008). All other anatomical risk factors were similar between groups. The 5-year freedom from neck-related event was 73% for the LD group and 85% for the ND group, P=.001. Type 1A endoleaks were more common in the LD group (12.2% vs 5.1%, P=.003). Migration > 5mm occurred similarly in both groups (7.8% vs 5.1%, P=.32). Neck-related secondary interventions were also more common among LD patients (13.3% vs 8.7%; P = .027). On multivariable regression analysis, LD group was an independent risk factor for neck-related adverse events (Hazard Ratio [HR]: 2.29; 95% confidence interval [CI], 1.37–3.83, P=0.002). Neck dilatation was greater among LD patients (median, 3 mm [IQR, 0–6] vs 2mm [IQR, 0–4]; P =.034) On multivariable analysis, LD was an independent predictor for neck dilatation > 10 % (HR: 1.61 CI 95% 1.08–2.39, P=.020). Survival at 5-years was 66.1% for LD and 71.2% for SD groups, P=.14. Conclusion: Standard EVAR in patients with large infrarenal necks requiring a 34- to 36-mm proximal endograft is independently associated to increased rate of neck related events and more neck dilatation. This subgroup of patients could be considered for more proximal seal strategies with fenestrated or branched devices, if unfit for open repair. Tighter surveillance following EVAR in these patients in the long term is also advised.
publishDate 2020
dc.date.none.fl_str_mv 2020-08-05T00:00:00Z
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dc.relation.none.fl_str_mv http://acvjournal.com/index.php/acv/article/view/297
https://doi.org/10.48750/acv.297
http://acvjournal.com/index.php/acv/article/view/297/178
dc.rights.driver.fl_str_mv Copyright (c) 2020 Angiologia e Cirurgia Vascular
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2020 Angiologia e Cirurgia Vascular
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
dc.source.none.fl_str_mv Angiologia e Cirurgia Vascular; Vol. 16 No. 2 (2020): June; 61-70
Angiologia e Cirurgia Vascular; Vol. 16 N.º 2 (2020): Junho; 61-70
2183-0096
1646-706X
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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