Postoperative Aortic Neck Dilation: Myth or Fact?

Abstract

The abdominal aorta is the most common site of an aortic aneurysm. The visceral and most proximal infrarenal segment (aneurysm neck) are usually spared and considered more resistant to aneurysmal degeneration. However, if an abdominal aortic aneurysm (AAA) is left untreated, the natural history of the aortic neck is progressive dilatation and shortening. This may have significant implications for patients undergoing endovascular repair of AAAs (EVAR) as endograft stability and integrity of the repair are dependent on an intact proximal seal zone. Compromised seal zones, caused by progressive diameter enlargement and foreshortening of the aortic neck, may lead to distal endograft migration, type Ia endoleak, aortic sac repressurization, and, ultimately, aortic rupture.

Keywords

endovascular repair - abdominal aortic aneurysm - aneurysm - aortic valve disease - endograft placement - repair - artery

• References

• 1 Propper BW, Rasmussen TE, Jones WT, Gifford SM, Burkhardt GE, Clouse WD. Temporal changes of aortic neck morphology in abdominal aortic aneurysms. J Vasc Surg 2010; 51 (05) 1111-1115
• 2 Illig KA, Green RM, Ouriel K, Riggs P, Bartos S, DeWeese JA. Fate of the proximal aortic cuff: implications for endovascular aneurysm repair. J Vasc Surg 1997; 26 (03) 492-499 , discussion 499–501
• 3 Falkensammer J, Oldenburg WA, Biebl M. , et al. Abdominal aortic aneurysm neck remodeling after open aneurysm repair. J Vasc Surg 2007; 45 (05) 900-905
• 4 Oberhuber A, Schwarz A, Hoffmann MH, Klass O, Orend K-H, Mühling B. Influence of different self-expanding stent-graft types on remodeling of the aortic neck after endovascular aneurysm repair. J Endovasc Ther 2010; 17 (06) 677-684
• 5 Georgakarakos E, Argyriou C, Schoretsanitis N. , et al. Geometrical factors influencing the hemodynamic behavior of the AAA stent grafts: essentials for the clinician. Cardiovasc Intervent Radiol 2014; 37 (06) 1420-1429
• 6 Jim J, Rubin BG, Geraghty PJ, Criado FJ, Fajardo A, Sanchez LAA. A 5-year comparison of EVAR for large and small aortic necks. J Endovasc Ther 2010; 17 (05) 575-584
• 7 Stanley BM, Semmens JB, Mai Q. , et al. Evaluation of patient selection guidelines for endoluminal AAA repair with the Zenith Stent-Graft: the Australasian experience. J Endovasc Ther 2001; 8 (05) 457-464
• 8 Antoniou GA, Georgiadis GS, Antoniou SA, Kuhan G, Murray D. A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. J Vasc Surg 2013; 57 (02) 527-538
• 9 Tassiopoulos AK, Monastiriotis S, Jordan WD, Muhs BE, Ouriel K, De Vries JP. Predictors of early aortic neck dilatation after endovascular aneurysm repair with EndoAnchors. J Vasc Surg 2017; 66 (01) 45-52
• 10 Kret MR, Tran K, Lee JT. Change in aortic neck diameter after endovascular aortic aneurysm repair. Ann Vasc Surg 2017; 43: 115-120
• 11 Monahan TS, Chuter TA, Reilly LM, Rapp JH, Hiramoto JS. Long-term follow-up of neck expansion after endovascular aortic aneurysm repair. J Vasc Surg 2010; 52 (02) 303-307
• 12 Soberón AB, de Garcia MM, Möll GG, Vigil BR, Krauel MA, Alvarez-Sala Walter R. Follow-up of aneurysm neck diameter after endovascular repair of abdominal aortic aneurysms. Ann Vasc Surg 2008; 22 (04) 559-563
• 13 Tsilimparis N, Dayama A, Ricotta II JJ. Remodeling of aortic aneurysm and aortic neck on follow-up after endovascular repair with suprarenal fixation. J Vasc Surg 2015; 61 (01) 28-34
• 14 Oberhuber A, Buecken M, Hoffmann M, Orend K-H, Mühling BM. Comparison of aortic neck dilatation after open and endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2012; 55 (04) 929-934
• 15 Malas MB, Ohki T, Veith FJ. , et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg 2005; 42 (04) 639-644
• 16 Guidoin R, Marois Y, Douville Y. , et al. First-generation aortic endografts: analysis of explanted Stentor devices from the EUROSTAR Registry. J Endovasc Ther 2000; 7 (02) 105-122
• 17 Zarins CK, Bloch DA, Crabtree T, Matsumoto AH, White RA, Fogarty TJ. Stent graft migration after endovascular aneurysm repair: importance of proximal fixation. J Vasc Surg 2003; 38 (06) 1264-1272 , discussion 1272
• 18 Kolvenbach R, Pinter L, Cagiannos C, Veith FJ. Remodeling of the aortic neck with a balloon-expandable stent graft in patients with complicated neck morphology. Vascular 2008; 16 (04) 183-188
• 19 de Donato G, Setacci F, Bresadola L. , et al; TriVascular Ovation Italian Study. Aortic neck evolution after endovascular repair with TriVascular Ovation stent graft. J Vasc Surg 2016; 63 (01) 8-15
• 20 Grisafi JL, Rahbar R, Nelms J. , et al. Challenging neck anatomy is associated with need for intraoperative endovascular adjuncts during endovascular aortic aneurysm repair (EVAR). Ann Vasc Surg 2011; 25 (06) 729-734
• 21 Deaton DH. Improving proximal fixation and seal with the HeliFx Aortic EndoAnchor. Semin Vasc Surg 2012; 25 (04) 187-192
• 22 Muhs BE, Jordan W, Ouriel K, Rajaee S, de Vries JP. Matched cohort comparison of endovascular abdominal aortic aneurysm repair with and without EndoAnchors. J Vasc Surg 2017; ;S0741-5214(17)32502-8