Midterm results of adjunctive neck therapies performed during elective infrarenal aortic aneurysm repair

Jayer Chung, Matthew A. Corriere, Ross Milner, Karthikeshwar Kasirajan, Atef Salam, Thomas F. Dodson, Elliott L. Chaikof, Ravi Kumar Veeraswamy

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective This study evaluated the durability of adjunctive endovascular neck procedures, including aortic cuffs, Palmaz stents (Cordis, Miami Lakes, Fla), and high-pressure balloon angioplasty, at managing intraoperative proximal neck complications during endovascular aortic aneurysm repair (EVAR). Methods This was a single-center retrospective review of EVARs. The primary outcome variable studied was survival free of a graft-related event (GRE). GRE was defined by the occurrence of one of the following: type I endoleak, sac enlargement, aneurysm rupture, death, or procedure related to the aortic neck. These outcome variables were assessed relative to the preoperative anatomic neck variables (neck length, diameter, degree of angulation, degree of circumferential thrombus, and presence of conicity), procedural variables (manufacturing type of graft, use of a Palmaz stent), and patient characteristics (age and presence of medical comorbidities). Outcomes were assessed by t tests, Pearson χ2, and Kaplan-Meier analysis, when appropriate. Results A total of 174 EVARs performed between January 2005 and December 2007 were evaluated. Fifty-six adjunctive procedures were performed, with a 97% primary-assisted exclusion rate. Patients who received an adjunctive therapy had similar freedom from a GRE compared with EVARs that did not require adjunctive therapy (35.5 ± 2.6 vs 34.8 ± 1.5 months, P = .31, log-rank test). Subset analysis identified a significant association between Palmaz stent placement at the time of EVAR and decreased freedom from GREs (hazard ratio, 2.87; 95% confidence interval, 1.21-6.77; P = .02). Conclusions Midterm results suggest that adjunctive therapies to manage intraoperative proximal neck complications do not compromise durability. The subset of patients requiring aortic neck Palmaz stent placement at the time of EVAR are among those at highest risk for subsequent GRE.

Original languageEnglish (US)
Pages (from-to)1435-1441
Number of pages7
JournalJournal of Vascular Surgery
Volume52
Issue number6
DOIs
StatePublished - Dec 2010

Fingerprint

Aortic Aneurysm
Neck
Stents
Transplants
Endoleak
Therapeutics
Endovascular Procedures
Balloon Angioplasty
Kaplan-Meier Estimate
Lakes
Aneurysm
Comorbidity
Rupture
Thrombosis
Confidence Intervals
Pressure
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Chung, J., Corriere, M. A., Milner, R., Kasirajan, K., Salam, A., Dodson, T. F., ... Veeraswamy, R. K. (2010). Midterm results of adjunctive neck therapies performed during elective infrarenal aortic aneurysm repair. Journal of Vascular Surgery, 52(6), 1435-1441. https://doi.org/10.1016/j.jvs.2010.06.163

Midterm results of adjunctive neck therapies performed during elective infrarenal aortic aneurysm repair. / Chung, Jayer; Corriere, Matthew A.; Milner, Ross; Kasirajan, Karthikeshwar; Salam, Atef; Dodson, Thomas F.; Chaikof, Elliott L.; Veeraswamy, Ravi Kumar.

In: Journal of Vascular Surgery, Vol. 52, No. 6, 12.2010, p. 1435-1441.

Research output: Contribution to journalArticle

Chung, J, Corriere, MA, Milner, R, Kasirajan, K, Salam, A, Dodson, TF, Chaikof, EL & Veeraswamy, RK 2010, 'Midterm results of adjunctive neck therapies performed during elective infrarenal aortic aneurysm repair', Journal of Vascular Surgery, vol. 52, no. 6, pp. 1435-1441. https://doi.org/10.1016/j.jvs.2010.06.163
Chung, Jayer ; Corriere, Matthew A. ; Milner, Ross ; Kasirajan, Karthikeshwar ; Salam, Atef ; Dodson, Thomas F. ; Chaikof, Elliott L. ; Veeraswamy, Ravi Kumar. / Midterm results of adjunctive neck therapies performed during elective infrarenal aortic aneurysm repair. In: Journal of Vascular Surgery. 2010 ; Vol. 52, No. 6. pp. 1435-1441.
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N2 - Objective This study evaluated the durability of adjunctive endovascular neck procedures, including aortic cuffs, Palmaz stents (Cordis, Miami Lakes, Fla), and high-pressure balloon angioplasty, at managing intraoperative proximal neck complications during endovascular aortic aneurysm repair (EVAR). Methods This was a single-center retrospective review of EVARs. The primary outcome variable studied was survival free of a graft-related event (GRE). GRE was defined by the occurrence of one of the following: type I endoleak, sac enlargement, aneurysm rupture, death, or procedure related to the aortic neck. These outcome variables were assessed relative to the preoperative anatomic neck variables (neck length, diameter, degree of angulation, degree of circumferential thrombus, and presence of conicity), procedural variables (manufacturing type of graft, use of a Palmaz stent), and patient characteristics (age and presence of medical comorbidities). Outcomes were assessed by t tests, Pearson χ2, and Kaplan-Meier analysis, when appropriate. Results A total of 174 EVARs performed between January 2005 and December 2007 were evaluated. Fifty-six adjunctive procedures were performed, with a 97% primary-assisted exclusion rate. Patients who received an adjunctive therapy had similar freedom from a GRE compared with EVARs that did not require adjunctive therapy (35.5 ± 2.6 vs 34.8 ± 1.5 months, P = .31, log-rank test). Subset analysis identified a significant association between Palmaz stent placement at the time of EVAR and decreased freedom from GREs (hazard ratio, 2.87; 95% confidence interval, 1.21-6.77; P = .02). Conclusions Midterm results suggest that adjunctive therapies to manage intraoperative proximal neck complications do not compromise durability. The subset of patients requiring aortic neck Palmaz stent placement at the time of EVAR are among those at highest risk for subsequent GRE.

AB - Objective This study evaluated the durability of adjunctive endovascular neck procedures, including aortic cuffs, Palmaz stents (Cordis, Miami Lakes, Fla), and high-pressure balloon angioplasty, at managing intraoperative proximal neck complications during endovascular aortic aneurysm repair (EVAR). Methods This was a single-center retrospective review of EVARs. The primary outcome variable studied was survival free of a graft-related event (GRE). GRE was defined by the occurrence of one of the following: type I endoleak, sac enlargement, aneurysm rupture, death, or procedure related to the aortic neck. These outcome variables were assessed relative to the preoperative anatomic neck variables (neck length, diameter, degree of angulation, degree of circumferential thrombus, and presence of conicity), procedural variables (manufacturing type of graft, use of a Palmaz stent), and patient characteristics (age and presence of medical comorbidities). Outcomes were assessed by t tests, Pearson χ2, and Kaplan-Meier analysis, when appropriate. Results A total of 174 EVARs performed between January 2005 and December 2007 were evaluated. Fifty-six adjunctive procedures were performed, with a 97% primary-assisted exclusion rate. Patients who received an adjunctive therapy had similar freedom from a GRE compared with EVARs that did not require adjunctive therapy (35.5 ± 2.6 vs 34.8 ± 1.5 months, P = .31, log-rank test). Subset analysis identified a significant association between Palmaz stent placement at the time of EVAR and decreased freedom from GREs (hazard ratio, 2.87; 95% confidence interval, 1.21-6.77; P = .02). Conclusions Midterm results suggest that adjunctive therapies to manage intraoperative proximal neck complications do not compromise durability. The subset of patients requiring aortic neck Palmaz stent placement at the time of EVAR are among those at highest risk for subsequent GRE.

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