Hostile neck anatomy (HNA) and its variation as a prognostic factor of endovascular aneurysm repair (EVAR) complication in abdominal aortic aneurysm (AAA)

Hostile neck anatomy: a prognostic factor for complication of EVAR

Abstract

Background: To determine the factors affecting early type 1A endoleak (T1aEL) in AAA patients receiving conventional EVAR. Methods: This was a prognostic factor study using the PROGRESS II framework. A retrospective cohort design included consecutive cases of AAA. Potential risk factors for T1aEL after EVAR were collected. Results: 19.1% (25/131) of AAA patients receiving conventional EVAR experienced T1aEL. Patients with T1aEL had larger aortic neck diameters, shorter neck lengths, longer operative times, more blood loss, and higher 1-year mortality. Multivariable risk ratio regression revealed that the prognostic factors for early T1aEL were a neck length < 10 mm (mRR 2.68, 95% CI 1.05 – 6.88, p-value = 0.039) and infrarenal angulation > 60 degrees (mRR 1.98, 95% CI 1.08 – 3.63, p-value = 0.027). Conclusion: Patients treated with conventional EVAR who developed T1aEL had a statistically significant increase in 1-year mortality compared to those without T1aEL. The factors contributing to T1aEL include neck length and neck angulation.