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AAA stent graft system linked to positive results regardless of patient neck length

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An abdominal aortic aneurysm stent graft system was associated with positive outcomes at 4 years regardless of patient neck length, according to new data from the ENGAGE registry.

Neck length, defined as the span of healthy aortic tissue between the top of the aneurysm and the lowest renal artery, determines the amount of landing zone available for the proximal end of a stent graft and is the characteristic most likely to limit patient eligibility for standard endovascular repair of abdominal aortic aneurysm (AAA), according to the study background.

Hence J.M. Verhagen, MD, PhD, and colleagues analyzed 1,237 patients from the ENGAGE registry who were implanted with the AAA stent graft system (Endurant, Medtronic). Of those, 137 had a short neck (8 mm to 15 mm in length) and 1,100 had a standard neck length (≥ 15 mm).

Hence J.M. Verhagen

The researchers investigated the influence of neck length on patient outcomes up to 4 years, including type 1 endoleaks, secondary procedures, main body migration and aneurysm rupture.

According to data presented at the Charing Cross International Symposium, delivery and deployment was successful in 99.4% of patients with a standard neck length and 100% of patients with a short neck length (P = .35).

The rate of uncorrected type 1 endoleak was 1.3% in those with a standard neck length and 0% in those with a short neck length (P = .18).

At 4-year follow-up, the researchers found no significant differences between the two groups in type 1 endoleak (short-neck group, 3.8%; standard-neck group, 2.4%) and type 1a endoleak (short-neck group, 0%; standard-neck group, 0.4%).

At 4 years, the groups showed similar results for secondary endovascular procedures (short-neck group, 7.8%; standard-neck group, 11.1%), ruptures (short-neck group, 0%; standard-neck group, 0.5%) or conversions to open repair (short-neck group, 0%; standard-neck group, 0.9%), and no main body migrations were reported in any patient, according to the researchers.

The device is approved for use in patients with a neck length at least 10 mm; 18% of patients in the registry had a neck length shorter than that, the researchers reported.

“While neck length remains an important consideration for endovascular repair of [AAAs], data from the ENGAGE registry show that the Endurant AAA stent graft system can address patients with short and standard necks equally well,” Verhagen, chief of vascular surgery at Erasmus Medical Center, Rotterdam, the Netherlands, said in a press release. “In light of these findings, endovascular repair using fenestrated or branched stent graft systems should be limited to patients with especially short necks coupled with other anatomical challenges. The findings also support offering standard endovascular repair with the Endurant system to a broad set of patients with the appropriate anatomy.” – by Erik Swain

Reference:

Verhagen HJM, et al. Abdominal Aortic Controversies. Presented at: Charing Cross International Symposium; April 28-May 1, 2015; London.
Disclosure: The registry is funded by Medtronic. Verhagen reports consulting for Medtronic, Phillips and W.L. Gore and serving as an investigator on several AAA stent graft studies sponsored by Medtronic.