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Stent graft system yields similar outcomes regardless of aortic neck length
In patients with neck length < 7 mm undergoing endovascular abdominal aortic aneurysm repair, an endograft stent system appears to yield results similar to those achieved in patients with ≥ 7 mm necks, according to recent findings.
In the study, researchers queried a multicenter, retrospective registry database that documented patients who underwent endovascular aneurysm repair with the endograft system (Ovation, Endologix) at 13 centers in Italy to identify 89 patients with a minimum CT follow-up of 24 months.
The mean patient age was 76 ± 2.4 years and the mean follow-up was 32 months (range, 24-50). An independent core laboratory evaluated CT scans, which were conducted preoperatively, 1 month postoperatively and at most recent follow-up.
Patients were stratified by proximal neck length ≥ 7mm (instructions-for-use group; n = 57) or < 7 mm (off-label group; n = 32). The primary endpoint was freedom from type Ia endoleak; secondary endpoints included primary clinical success, freedom from rupture, freedom from migration, and freedom from neck dilatation > 2 mm in the collar and sealing zones.
The researchers found that the instructions-for-use group had a 96.5% rate of primary technical success (one type Ia endoleak and one iliac graft occlusion) and the off-label group had a 96.9% rate of primary technical success (P = .8). A femorofemoral bypass was used to treat the iliac graft occlusion in the instructions-for-use group (98.3% rate of secondary technical success) and the endoleak was diminished after intraoperative balloon angioplasty and was gone by the 1-month CT scan.
At 3 years, Kaplan-Meier analysis revealed no aneurysm-related deaths, ruptures, stent-graft migrations or neck enlargements. No differences between the strata were documented in terms of type Ia endoleak (instructions-for-use group, 98.2%; off-label group, 96.8%; HR = 0.55; 95% CI, 0.02-9.71) or freedom from any device-related reintervention (92.8% for instructions-for-use group vs. 96.4% for off-label group; HR = 2.42; 95% CI, 0.34-12.99). The mean diameter change in the sealing zone was –0.05 ± 0.8 mm in the instructions-for-use group and –0.1 ± 0.5 mm in the off-label group.
“Use of the Ovation stent-graft in patients with neck length < 7 mm achieved midterm outcomes no different from patients with ≥ 7-mm-long necks, proving that the Ovation sealing ring creates uniform, continuous wall apposition with a circumferential nonexpansive seal.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.