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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Sirignano P., Capoccia L., Menna D., Mansour W., Speziale F.
Vascular and Endovascular Surgery Division, Department of Surgery “Paride Stefanini”, Policlinico Umberto I, “Sapienza” University of Rome, Italy
INTRODUCTION: Extreme complex aortic anatomies still represent the major limit of endovascular aneurysms repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA). Aim of this study is to evaluate results of EVAR with Ovation stent‐graft in extremely complex aortic anatomies.
MATERIALS AND METHODS : A single center study was retrospectively conducted on a prospectively compiled computerized database between July 2012 and July 2014. Twenty‐one elective patients with atherosclerotic AAA were included. All patients were judged unfit for or refused an open approach. In all of them, extremely complex anatomies features contraindicated EVAR by common endografts. Patients’ outcomes were evaluated on the basis of anatomical features: challenging proximal aortic neck (non-cylindrical, short, severely angulated, enlarged, thrombosed) and challenging iliac artery accesses (angulated and narrowed). Technical and clinical successes were defined as the absence of intraoperative surgical conversion and aneurysm related mortality, respectively. Reintervention, morbidity and mortality rates during follow‐up were also recorded.
RESULTS: all patients were male; mean age was 75.6±7.2 years. In 14 patients (66.7%) neck length was <10mm, a non-‐cylindrical neck was present in 15 patients (71.4%) and a severe neck thrombosis was registered in 13 patients (61.9%). Only 1 patient (4.8%) had no iliac tortuosity, 9 (42.8%) patients had severe tortuosity at least on one iliac access and 7 (33.3%) on both. Technical and clinical successes were achieved in all cases. Neither death nor reinterventions were observed in the present series. At a mean follow‐up of 9±5 (3‐27) months, only one patient presented an iliac leg thrombosis.
CONCLUSION: Our limited and preliminary experience seems to show that Ovation stent‐graft may widen the range of AAAs suitable for standard EVAR. Early results, even in patients with challenging anatomies, are encouraging but a longer follow‐up is mandatory.