The Influence of Unfavorable Aortoiliac Anatomy on Short-Term Outcomes after Endovascular Aortic Repair

Background: Endovascular aortic repair (EVAR) is widely performed to treat infrarenal abdominal aortic aneurysms (AAAs), and related techniques and devices continue to be developed. Although continuous attempts have been made to perform EVAR in patients with unfavorable aortic anatomy, the outcomes are still controversial. This study examined the short-term outcomes of EVAR for the treatment of infrarenal AAAs in patients with a 'hostile' neck and unfavorable iliac anatomy. Methods: Thirty-eight patients who underwent EVAR from January 2012 to December 2017 were enrolled in this study. A hostile neck was defined based on neck length, angulation, the presence of an associated thrombus, or a conical shape. Unfavorable iliac anatomy was considered to be present in patients with a short common iliac artery (<15 mm) or the presence of aneurysmal changes. Results: No perioperative mortality was recorded. No significant differences were found depending on the presence of a hostile neck, but aneurysmal sac shrinkage was significantly less common in the group with unfavorable iliac anatomy (p=0.04). A multivariate analysis performed to analyze the risk factors for aneurysmal progression revealed only unfavorable iliac anatomy to be a risk factor (p=0.02). Conclusion: Patients with unfavorable aortic anatomy showed relatively satisfactory short-term outcomes after EVAR. No difference in the surgical outcomes was observed in patients with a hostile neck. However, unfavorable iliac anatomy was found to inhibit the shrinkage of the aneurysmal sac.