Friendly Neck Anatomy Does Not Prevent Neck-Related Adverse Events After EVAR

Paavo Paajanen; Jari Karjalainen; Marianne Jaroma; Mika Tarkiainen; Hannu Manninen; Kimmo Mäkinen; Jussi Kärkkäinen; Petri Saari

doi:10.1016/j.avsg.2023.06.031

Friendly Neck Anatomy Does Not Prevent Neck-Related Adverse Events After EVAR

Ann Vasc Surg. 2023 Jul 15:104:71-80. doi: 10.1016/j.avsg.2023.06.031. Online ahead of print.

Authors

Paavo Paajanen¹, Jari Karjalainen², Marianne Jaroma², Mika Tarkiainen³, Hannu Manninen⁴, Kimmo Mäkinen², Jussi Kärkkäinen², Petri Saari³

Affiliations

¹ Heart Center, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Kuopio, Finland. Electronic address: paajanenpaavo@hotmail.com.
² Heart Center, Kuopio University Hospital, Kuopio, Finland.
³ Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
⁴ University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.

PMID: 37454900
DOI: 10.1016/j.avsg.2023.06.031

Abstract

Background: Life-long follow-up after endovascular aneurysm repair (EVAR) is costly and burdensome to the patient. Follow-up should be stratified based on the risk of EVAR failure. Aneurysm neck is thought to be the single most important risk factor. This study investigated neck anatomy as a predictor of neck-related adverse events after EVAR.

Methods: This retrospective single-center study included consecutive patients undergoing elective EVAR for infrarenal abdominal aortic aneurysms between 2011 and 2016 (n = 222) who were followed with yearly imaging until December 2020. Hostile neck was defined as neck length ≤15 mm, width ≥28 mm, angulation ≥60°, calcification, or thrombus ≥50% of circumference or conical neck based on preoperative computed tomography angiography. Neck-related adverse event was defined as aneurysm rupture, any neck-related reintervention or type 1a endoleak during follow-up.

Results: Ninety (41%) patients had hostile neck and 132 (59%) had friendly neck. There were no differences in 30-day mortality (1% vs. 1%, P = 0.78), major adverse events (20% vs. 16%, P = 0.43) or reinterventions during the hospital stay (8% vs. 4%, P = 0.20) between patients with hostile and friendly neck. Estimated survival at 1 year was 89 ± 3% for hostile neck and 95 ± 2% for friendly neck patients (P < 0.01). Five-year survival estimates were 51 ± 6% and 66 ± 4%, respectively. Aneurysm-related mortality was higher after 6 years in patients with hostile neck (P < 0.01). Twenty-four patients (11%) suffered neck-related adverse events with mean time-to-event of 3.3 ± 2.8 years; there were no differences between the groups stratified by neck anatomy. Incidentally, preoperative aneurysm diameter was found to be an independent risk factor for neck-related adverse events and aneurysm-related mortality; 53 patients (24%) had aneurysm diameter ≥70 mm, which was associated with nearly 4-fold risk of neck-related complications during the follow-up.

Conclusions: Friendly neck anatomy may not protect from neck-related adverse events after EVAR in the long-term. Especially patients with large aneurysms should be followed closely.