Influence of Severe Infrarenal Aortic Neck Angulation on Complications at the Proximal Neck Following Endovascular AAA Repair: A EUROSTAR Study

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Abstract
Purpose: To examine the influence of severe infrarenal neck angulation (SNA) on complications after endovascular repair of abdominal aortic aneurysm (AAA). Methods: From October 1996 to January 2006, 5183 patients who underwent endovascular aneurysm repair using a Talent, Zenith, or Excluder stent-graft were enrolled into the EUROSTAR registry. Incidence of proximal type I endoleak, stent-graft migration, proximal neck dilatation, aneurysm rupture, secondary interventions, and all-cause and aneurysm-related mortality were compared between patients with and without severe infrarenal neck angulation (>60° angle between the infrarenal aortic neck and the longitudinal axis of the aneurysm). Results: In the short term (before discharge), proximal type I endoleak (OR 2.32, 95% Cl 1.60 to 3.37, pConclusion: Severe infrarenal aortic neck angulation was clearly associated with proximal type I endoleak, while the relationship with stent-graft migration was not clear. Excluder, Zenith, and Talent stent-grafts perform well in patients with severe neck angulation, with only a few differences among devices.

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