Endovascular aneurysm repair for abdominal aortic aneurysms with unfavorable neck anatomy: a single-center retrospective cohort study from Vietnam

Background: Abdominal aortic aneurysms (AAAs) are a fatal condition worldwide. Currently, endovascular aneurysm repair (EVAR) is the primary surgical method for the repair. This paper aims to evaluate the outcomes of AAAs with hostile neck anatomy in patients who underwent EVAR. Methods: The retrospective cohort study enrolled all the patients with hostile neck anatomy of infrarenal AAA who underwent EVAR from January 2020 to August 2023 at C.R. Hospital. The primary endpoint was the successful outcome following EVAR within 30 days, and the secondary endpoints were the relevant occurrence of type Ia endoleak, stent-graft migration, secondary rupture, and reintervention after 30 days. Computed tomography angiography was the gold standard for preprocedural planning and postprocedural surveillance. Results: In total, our study included 41 patients with a mean age of 73.9 years. Among them, nearly 80% of cases were male. The participants were observed for a mean time of 18.51 +/- 8.34 (4-40) months, an estimated blood loss of 130.5 +/- 75.72 (50-500) ml, and a total length of stay of 4.8 +/- 1.8 (2-9) days. The most common complication within 30 days was type II endoleak. After 30 days of intervention, the mortality rate was significantly higher in a group with a length of short neck of aneurysm of less than 15 mm. Conclusions: Our findings suggest that EVAR for infrarenal AAA with unfavorable neck anatomy could be considerably acceptable where applicable. Severe complications occur commonly after surgical intervention due to accompanying diseases. Management by a multidisciplinary team and postoperative care are potentially necessary.