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Comparative Study of Clinical Outcome of EVAR in Large Diameter Aortic Necks (>31 mm) versus Smaller Neck: Word of Caution
Ali F. AbuRahma, MD, Trevor DerDerian, MD, Zachary T. AbuRahma, DO, Michael Yacoub, MD, L Scott Dean, PhD, MBA, Stephen M. Hass, MD, Shadi Abu-Halimah, MD, Albeir Y. Mousa, MD.
West Virginia University, Charleston Division, Charleston, WV, USA.

Objective(s): A significant number of patients with large aortic neck diameters have undergone endovascular aortic aneurysm repair (EVAR). This study compares clinical outcomes in patients with large (>31 mm) versus small aortic neck diameters (≤28 and ≤31 mm). Methods: Prospectively collected data of 741 EVAR patients were analyzed. Patients were classified into: ≤28 mm (Group A), >28-31 mm (Group B), and >31 mm (Group C). Logistic regression and Kaplan Meier analyses were used to compare various clinical outcomes.Results: 688 patients had defined aortic neck diameter: 592 in Group A, 63 in Group B, and 33 in Group C. The mean follow-up was 25.2 months for Groups A and B versus 31.8 months for Group C. Clinical characteristics were similar in all groups, except for age (patients were older in Groups B and C); and more patients were done outside the IFU in Group C. Rates of early Type I endoleaks and interventions were 11%, 11%, and 27% (p=0.228); and 9%, 10%, and 15% (p=0.498) for Groups A, B, and C, respectively. When Group C versus Groups A and B combined (>31 mm versus ≤31 mm) were compared, these rates were 27% versus 11% (p=0.0118) and 15% versus 9%. Rates of late Type I endoleak were 2.9%, 3.4%, 13.8% (p=0.0193); sac expansion 4.6%, 5.1%, 17.2% (p=0.0239); and late intervention 3.8%, 3.4%, 17.2% (p=0.0114). When Group C was compared with Groups A and B combined, these late rates were: 13.8% versus 3% for endoleak (p=0.0144); 17.2% versus 4.6% (p=0.0133) for sac expansion; 17.2% versus 3.8% for late reintervention (p=0.0065). Rates of freedom from late Type I endoleak, re-intervention, and sac expansion at three years were: 88%, 91%, and 81%for Group C versus 97%, 92%, 96% for Groups A and B combined (p=0.017 for sac expansion). The survival rates at 3 years were 68% for Group C versus 90% for Groups A and B combined (p<0.001). Multivariate logistic regression analysis showed that Group C had an odds ratio of 6.1 (2.2-16.8) for mortality; 4.7 (1.4-15.5) for sac expansion; and 4.9 (1.4-17.4) for late Type I endoleak.Conclusions: Patients with large aortic neck diameters (>31 mm) had higher rates of early and late Type I endoleak, sac expansion, late intervention, and survival; and a word of caution should be used.


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