Endovascular Grafting in Patients with Short Proximal Necks: An Analysis of Short-Term Results

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Abstract
Objectives: To evaluate the safety of endovascular graft placement in patients with short proximal aneurysm necks, and assess factors contributing to endoleak formation. Methods: 55 patients were enrolled over a two year period from five centers following the placement of a Talent® endograft with a suprarenal stent. Preoperative and 30-day post-implant CT scans were retrospectively analyzed in a blinded fashion by two physicians. Aortic measurements were obtained, the amount of thrombus was subjectively graded, and any extravasation of contrast into the aneurysm sac defined an endoleak. The data were analyzed using a t-test. Analyses compared patients with proximal necks < 10 mm (SN), n = 13) to those with longer necks (LN. n = 42), and then contrasted patients with endoleaks ( n = 12), to those without ( n = 43). Results: Endoleak rates were identical in the SN and LN groups (21 and 23%). Maximal aneurysm size was larger in the SN group (63 vs 56 mm, P < 0.05). Endoleaks were more frequently noted in larger aneurysms ( P < 0.05), but not related to SN ( P = 0.6). There was no correlation between endoleaks and the amount of thrombus, aneurysm length, proximal neck diameter or other morphologic characteristics. One of 12 endoleaks resulted from a problem with proximal fixation, nine were due to perfusing vessels, and two were undefined. The proximal neck diameter increased (0.9 mm) over the 30 days ( P < 0.005). Conclusions: Short-term proximal fixation can be achieved in proximal necks measuring less than 10 mm. The narrow margin of acceptable seal mandates careful follow-up. Larger aneurysms were associated with an increased incidence of endoleaks. SNs were associated with larger aneurysms, but not with an increased incidence of endoleaks. Proximal neck dilation was noted, but likely relates to the placement of an oversized endograft during this brief period of observation.