Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy

A Korean Multicenter Retrospective Study

Yong Sun Jeon, Young Kwon Cho, Myung Gyu Song, Tae-Seok Seo, Jeong Ho Kim, Soon Young Song, Sam Yeol Lee

Research output: Contribution to journalArticle

Abstract

Purpose: We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal® stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle CloseSPigtSPi 60°). Materials and Methods: We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71 ± 11 years; age range 32–87 years; mean follow-up 50 ± 12 months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan–Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention. Results: The primary technical success rate (success within 24 h after EVAR) was 100% (24/24). The survival rate was 96 ± 8% at 1 month, 6 months, 1 year, and 3 years, and 87 ± 18% at 5 years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14 days and rhabdomyolysis at 32 months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1 month) (P = 0.001). Conclusion: Kilt-based EVAR with Seal® stent-grafts for AAAs with a severely angulated neck (angle CloseSPigtSPi 60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.

Original languageEnglish
Pages (from-to)554-563
Number of pages10
JournalCardioVascular and Interventional Radiology
Volume41
Issue number4
DOIs
Publication statusPublished - 2018 Apr 1

Fingerprint

Abdominal Aortic Aneurysm
Multicenter Studies
Aneurysm
Anatomy
Retrospective Studies
Neck
Endoleak
Stents
Survival Rate
Transplants
Endovascular Procedures
Rhabdomyolysis
Mortality
Cerebral Hemorrhage
Reoperation
Multivariate Analysis

Keywords

  • Abdominal aortic aneurysm
  • Abdominal aortic disease
  • Aortic stent-graft
  • Endovascular aneurysm repair

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy : A Korean Multicenter Retrospective Study. / Jeon, Yong Sun; Cho, Young Kwon; Song, Myung Gyu; Seo, Tae-Seok; Kim, Jeong Ho; Song, Soon Young; Lee, Sam Yeol.

In: CardioVascular and Interventional Radiology, Vol. 41, No. 4, 01.04.2018, p. 554-563.

Research output: Contribution to journalArticle

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abstract = "Purpose: We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal{\circledR} stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle CloseSPigtSPi 60°). Materials and Methods: We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71 ± 11 years; age range 32–87 years; mean follow-up 50 ± 12 months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan–Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention. Results: The primary technical success rate (success within 24 h after EVAR) was 100{\%} (24/24). The survival rate was 96 ± 8{\%} at 1 month, 6 months, 1 year, and 3 years, and 87 ± 18{\%} at 5 years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14 days and rhabdomyolysis at 32 months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1 month) (P = 0.001). Conclusion: Kilt-based EVAR with Seal{\circledR} stent-grafts for AAAs with a severely angulated neck (angle CloseSPigtSPi 60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.",
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T1 - Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy

T2 - A Korean Multicenter Retrospective Study

AU - Jeon, Yong Sun

AU - Cho, Young Kwon

AU - Song, Myung Gyu

AU - Seo, Tae-Seok

AU - Kim, Jeong Ho

AU - Song, Soon Young

AU - Lee, Sam Yeol

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N2 - Purpose: We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal® stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle CloseSPigtSPi 60°). Materials and Methods: We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71 ± 11 years; age range 32–87 years; mean follow-up 50 ± 12 months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan–Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention. Results: The primary technical success rate (success within 24 h after EVAR) was 100% (24/24). The survival rate was 96 ± 8% at 1 month, 6 months, 1 year, and 3 years, and 87 ± 18% at 5 years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14 days and rhabdomyolysis at 32 months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1 month) (P = 0.001). Conclusion: Kilt-based EVAR with Seal® stent-grafts for AAAs with a severely angulated neck (angle CloseSPigtSPi 60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.

AB - Purpose: We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal® stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle CloseSPigtSPi 60°). Materials and Methods: We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71 ± 11 years; age range 32–87 years; mean follow-up 50 ± 12 months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan–Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention. Results: The primary technical success rate (success within 24 h after EVAR) was 100% (24/24). The survival rate was 96 ± 8% at 1 month, 6 months, 1 year, and 3 years, and 87 ± 18% at 5 years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14 days and rhabdomyolysis at 32 months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1 month) (P = 0.001). Conclusion: Kilt-based EVAR with Seal® stent-grafts for AAAs with a severely angulated neck (angle CloseSPigtSPi 60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.

KW - Abdominal aortic aneurysm

KW - Abdominal aortic disease

KW - Aortic stent-graft

KW - Endovascular aneurysm repair

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