Approach and efficacy of endovascular repair for abdominal aortic aneurysm with hostile proximal landing zone

Objective: To explore the option and efficacy of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with hostile aortic proximal landing anatomy. Methods: The clinical data of 51 AAA patients with hostile aortic proximal landing anatomy treated by EVAR from January 2010 to June 2012 at our hospital was retrospectively analyzed. There were 44 males and 7 females with a mean age of 73 years (range: 42-94). The anatomic measurements included a diameter of aneurysm body 32-100 mm, a length of proximal neck 0-50 mm, a width of proximal neck 15-40 mm and infrarenal angulation 15-80 degrees. In addition, there were calcification (n=10) and thrombus lining with aortic neck (n=15) and irregular shape of aortic neck (n=5) respectively. The stent-grafts were deployed by 4 femoral arteries. Results: Many types of aortic stent were used, such as Endurant (n=9), Talent (n=5), Zenith (n=31), Hercules (n=5), Palmaz/CUFF (n=6) and multilayer bare-stent (n=2). And 11 patients underwent fenestrated EVAR and 31 with chimney EVAR involving renal artery (39 branches), superior mesenteric artery (3 branches) and celiac trunk (3 branches). The primary technical success rate was 100%. The perioperative endoleak rate was 17.6%. During the mean follow-up period of 13 months (2-28), the primary patency of stent was 96.1% and the thrombus rate of aneurysm 82.4%. Two cases of new endoleak and 3 cases of residual endoleak underwent secondary intervention. In addition, long-term follow-up was required for 3 patients with stent-graft migration (<10 mm). There was no case of death, infection, occlusions, ischemia of lower limbs, aneurysm expansion or rupture. Conclusion: A variety of EVAR options are both safe and efficacious in the treatment of AAA with hostile proximal landing zone.