Plug Maaike, Holewijn Suzanne, Meershoek Armelle, van der Veen Daphne, Reijnen Michel M P J
Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands.
J Clin Med. 2025 Jun 11;14(12):4133. doi: 10.3390/jcm14124133.
Wide and conical-shaped infrarenal necks are risk factors for neck-related complications after Endovascular Aorta Aneurysm Repair (EVAR). The aim of this study is to investigate the performance of the Endurant endoprosthesis in wide/conical-shaped aortic neck anatomies compared to its performance in a normal infrarenal neck (reference group). : A single-center, retrospective observational cohort study was performed, including consecutive subjects with an infrarenal abdominal aortic aneurysm, treated electively with an Endurant endoprosthesis. The primary endpoint was the freedom from aneurysm-related reinterventions through 1 year. Secondary endpoints included proximal fixation failure, type IA endoleak, stent migration, aneurysm sac remodeling, aneurysm-related mortality, freedom from reinterventions throughout available follow-up, and rupture. : A total of 268 patients were included, with a mean age of 73.3 years, and 85.1% were male. Freedom from aneurysm-related reinterventions was significantly lower in the wide-neck group (60.0%) compared to the reference group (81.1%; = 0.018) but not for the conical-neck group (70.3%; = 0.286). Median time to first reintervention was 1.7 (IQR 0.8; 4.4 years) in the reference group, 2.9 years (IQR 0.3; 5.0 years) in the wide-neck group ( = 0.547) and 3.8 years (IQR 0.4; 6.5) in the conical-neck group ( = 0.123). The proximal fixation failure rate was 7.4% in the wide-neck group compared to 3.3% in the reference group ( = 0.155) and 1.7% in the conical-neck group ( = 0.525). The type IA endoleak rate was 4.9% in the wide-neck group versus 3.3% in the reference group ( = 0.250). : In the group with wide necks, reintervention-free survival was lower compared to the reference group, which seems to be driven by proximal fixation failure.
肾下型颈部宽阔且呈圆锥形是血管腔内腹主动脉瘤修复术（EVAR）后发生颈部相关并发症的危险因素。本研究的目的是比较Endurant人工血管在宽阔/圆锥形主动脉颈部解剖结构中的性能与其在正常肾下型颈部（参照组）中的性能。：进行了一项单中心回顾性观察队列研究，纳入连续接受Endurant人工血管择期治疗的肾下腹主动脉瘤患者。主要终点是1年内无动脉瘤相关再干预。次要终点包括近端固定失败、IA型内漏、支架移位、动脉瘤囊重塑、动脉瘤相关死亡率、在整个可用随访期内无再干预以及动脉瘤破裂。：共纳入268例患者，平均年龄73.3岁，85.1%为男性。与参照组（81.1%；P = 0.018）相比，宽阔颈部组无动脉瘤相关再干预的比例显著较低（60.0%），但圆锥形颈部组（70.3%；P = 0.286）并非如此。参照组首次再干预的中位时间为1.7年（四分位间距0.8；4.4年），宽阔颈部组为2.9年（四分位间距0.3；5.0年）（P = 0.547），圆锥形颈部组为3.8年（四分位间距0.4；6.5年）（P = 0.123）。宽阔颈部组近端固定失败率为7.4%，参照组为3.3%（P = 0.155），圆锥形颈部组为1.7%（P = 0.525）。宽阔颈部组IA型内漏率为4.9%，参照组为3.3%（P = 0.250）。：在宽阔颈部组中，无再干预生存率低于参照组，这似乎是由近端固定失败导致的。
