Midterm results of endovascular aortic repair in patients with hostile neck

Objectives: This study aims to investigate the feasibility of endovascular aortic aneurysm repair (EVAR) in patients with a hostile aortic neck anatomy. Patients and methods: Between July 2010 and September 2019, a total of 54 patients (18 males, 36 females; mean age 77.0±6.2 years; range 63 to 89 years) with a hostile neck anatomy (proximal aortic neck angulation >60°; proximal aortic diameter >28 mm; proximal aortic length <15 mm; conical aortic neck) were retrospectively analyzed. Stent graft was inserted via infrarenal fixation in 24 patients, while it was inserted via suprarenal fixation in 30 patients. Chimney technique was used in three patients with a conical aortic neck. Results: The mean aneurysm diameter was 73.1±6.8 mm, while the mean proximal aortic neck angulation was 86.2±13.8°. The mean proximal aortic length was 13.0±3.6 mm, while the mean aortic neck diameter was 28.5±2.3 mm. Technical success rate was 100% for stent graft insertion. The mean operation duration was significantly longer in female patients than males (p<0.05). Type 1 endoleak was developed in 13 patients, while a second intervention was required in two patients. No mortality or graft migration was observed. Conclusion: Together with the advances in graft technologies, novel techniques, and increased experience of surgeons, EVAR has become a safe technique which can be employed in patients with a hostile aortic neck anatomy.