Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Aortic Disease
Outcomes and Morphologic Changes After Endovascular Repair for Abdominal Aortic Aneurysms With a Severely Angulated Neck
– A Device-Specific Analysis –
Katsuyuki HoshinaTakafumi AkaiToshio TakayamaMasaaki KatoTatsu NakazawaHiroyuki OkamotoKunihiro ShigematsuTetsuro Miyata
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2013 Volume 77 Issue 8 Pages 1996-2002


Background: With respect to endovascular aneurysm repair (EVAR), the development of advanced techniques and devices, namely, Cook Zenith and Gore Excluder, has helped overcome device-related problems, including device migration. Deformities of abdominal aortic aneurysms (AAAs) can influence the long-term outcome of EVAR. The post-implantation behavior of stent grafts in AAAs with a severely angulated neck (SAN) was examined. Methods and Results: Among 190 AAA patients who underwent EVAR, 46 had SAN of more than 60 degrees. The post-implantation angle and adverse events were evaluated. Forty-one patients (89%) showed straightening of the neck angle immediately after the operation (early), with 2 types of subsequent (late) configuration changes — recoil and additional straightening. Among 34 Excluder patients, 29 showed immediate straightening, without additional straightening and 8 exhibited recoil. All 12 Zenith patients showed immediate straightening; 7 subsequently exhibited additional straightening, and none of them showed recoil. A difference (P=0.04) was noted between the 2 devices in the late angle changes. In all cases, no migration was observed at the proximal sites. Conclusions: The post-implantation configuration changes in stent placement in AAA patients with SAN were different for Excluder and Zenith. Appropriate device selection and proper planning of the procedure is necessary for EVAR.  (Circ J 2013; 77: 1996–2002)

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