Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy: A Korean Multicenter Retrospective Study

摘要

Abstract Purpose We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal_(?)stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle?>?60°). Materials and Methods We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71?±?11?years; age range 32–87?years; mean follow-up 50?±?12?months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan–Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention. Results The primary technical success rate (success within 24?h after EVAR) was 100% (24/24). The survival rate was 96?±?8% at 1?month, 6?months, 1?year, and 3?years, and 87?±?18% at 5?years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14?days and rhabdomyolysis at 32?months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1?month) ( P ?=?0.001). Conclusion Kilt-based EVAR with Seal_(?)stent-grafts for AAAs with a severely angulated neck (angle?>?60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.