Endovascular Treatment of Abdominal Aortic Aneurysm with Hostile Artery Access: A Multi-Center Retrospective Study

Xingyi Tang; Jiaxuan Feng; Yubin Li; Shun Xiao; Heng Zhang; Wenjing Huang; Mingyuan Liu; Junjun Liu; Mingjin Guo

doi:10.1016/j.avsg.2024.10.008

Endovascular Treatment of Abdominal Aortic Aneurysm with Hostile Artery Access: A Multi-Center Retrospective Study

Ann Vasc Surg. 2024 Nov 21:S0890-5096(24)00672-1. doi: 10.1016/j.avsg.2024.10.008. Online ahead of print.

Authors

Xingyi Tang¹, Jiaxuan Feng², Yubin Li³, Shun Xiao¹, Heng Zhang¹, Wenjing Huang¹, Mingyuan Liu⁴, Junjun Liu⁵, Mingjin Guo⁶

Affiliations

¹ Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Shandong, China.
² Department of Vascular Surgery, Shanghai general hospital, Intervention center, Medical school of Shanghai Jiaotong University, Shanghai, China.
³ Department of Vascular Surgery, Linyi Peoples' Hospital, Shandong, China.
⁴ Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China. Electronic address: dr.mingyuanliu@pku.edu.cn.
⁵ Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Shandong, China. Electronic address: 503777344@qq.com.
⁶ Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Shandong, China. Electronic address: qduahvasc@163.com.

PMID: 39580025
DOI: 10.1016/j.avsg.2024.10.008

Abstract

Purpose: The objective of this study is to document our experience using low-profile endografts for the endovascular repair of abdominal aortic aneurysms (AAAs) in cases where access arteries are challenging, commonly referred to as hostile access arteries.

Methods: Data regarding patients with narrow or tortuous access arteries who underwent endovascular aortic repair (EVAR) using low-profile endografts at three tertiary medical centers between January 2020 and December 2022 were retrospectively collected and analyzed. A total of 76 patients were enrolled in the study. The primary endpoints included technical success, occurrence of endoleaks, endograft occlusion, and any device- or procedure-related major adverse events. Secondary endpoints were assessed for endograft migration, endograft fracture, access site complications, and aneurismal sac shrinkage.

Results: The mean follow-up duration was 28.1±9.0 months (range, 14.0-54.0). Among the patients, 32 (42.1%) had narrow artery access (diameter ≤ 6.0 mm), 29 (38.2%) had access arteries characterized by tortuosity, and 15 (19.7%) patients presented with both narrow and tortuous access arteries. Technical success was achieved in 73 (96.1%) cases. A total of four (5.2%) patients received reintervention due to endograft occlusion. During follow-up, a total of eight (10.5%) type II endoleaks were observed during follow-up without intervention, and the endoleak disappeared in the follow-up period. Abdominal aortic aneurysm-sac shrinkage and stability were observed in 25 (32.9%) and 51 (67.1%) cases, respectively. The overall survival rate was 98.7%. The perioperative and follow-up outcomes for the groups categorized by 'Narrow arteries', 'Tortuous arteries', and 'Narrow and Tortuous arteries' did not show statistically significant differences when compared to each other.

Conclusion: This preliminary investigation indicates that the use of low-profile endografts is associated with safety and effectiveness within the observed period.

Keywords: abdominal aortic aneurysm; endovascular aortic repair; femoral artery; graft occlusion; iliac artery.