Language：English   Publisher：Vascular  

Background: The accumulation of adipose tissue, such as increased epicardial adipose tissue volume (EATV) and visceral fat area (VFA), is associated with the development of cardiovascular (CV) disease. However, little information is available regarding the relationship between EATV and CV death in patients who undergo open surgical repair (OSR) for abdominal aortic aneurysms (AAAs). The aim of this study was to evaluate the association between adipose tissue and CV death and to identify factors related to CV death after AAA repair. Methods: Between June 2005 and December 2019, a total of 739 patients underwent OSR for AAA with or without iliac artery aneurysm and isolated iliac artery aneurysm at our institution. AAA with a diameter of 50 mm or more and iliac artery aneurysm with 35 mm or greater were considered to be a surgical indication. Patients with ruptured AAAs and infected AAAs were excluded. Four hundred ninety-two patients with preoperative optimal computed tomography (CT) scans were included in this study. The EATV, VFA, and subcutaneous fat area (SFA) were retrospectively quantified from preoperative noncontrast CT images. The EATV index was defined as the EATV divided by the body surface area, and the VFA index and SFA index were defined as each number divided by height squared. The correlations among the EATV, VFA, and SFA indices were analyzed, and the cut-off values of the parameters for predicting CV death after OSR for AAA patients were determined via receiver operating characteristic curves. Regression analysis was used to assess predictors of CV death during the follow-up period. Cox hazard regression analysis was performed. Results: The median age was 71 years, and 12% of the patients were female. The median body mass index was 23.1 kg/m². The prevalence of comorbidities was 31% for coronary artery disease, 9% for stroke, 15% for diabetes, and 41% for chronic kidney disease. The median follow-up period for overall patients was 62.5 months (interquartile range: 33.7–99.6). The EATV index was positively correlated with the VFA (R = 0.615, p <.001) and SFA (R = 0.421, p <.001) indices. The cut-off value of the EATV index was 73.8 cm³/m² (area under the curve (AUC); 0.566). Multivariate analysis revealed that age ≥75 years and an EATV index ≥73.8 cm³/m² were significantly associated with CV death after AAA repair. Conclusions: This study demonstrated that the EATV index was associated with CV death in patients who underwent OSR for AAA, suggesting its potential utility as a novel risk stratification tool for personalized postoperative management.

DOI： 10.1177/17085381251342332

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Scopus

PubMed

Language：English   Publisher：Journal of Endovascular Therapy  

Purpose: Recent studies suggested that continuous clotting renewal in thrombi plays a central role in sac enlargement after endovascular aneurysm repair (EVAR). We reviewed patients with persistent type 2 endoleak (T2EL) to estimate the impact of D-dimer level on sac enlargement. Methods: A retrospective review of elective EVAR for infrarenal abdominal aortic aneurysm performed between June 2007 and February 2020. Persistent T2EL was defined as T2EL confirmed at both the 6 and 12 month contrast-enhanced computed tomography (CECT) follow-ups. “Isolated” T2EL was defined as T2EL without other types of endoleak within 12 months. Patients with >2 year follow-up, persistent isolated T2ELs, and D-dimer level data at 1 year (DD1Y) were included. Patients with any reintervention within 12 months were excluded. The association between DD1Y and aneurysm enlargement (AnE), defined as a ≥5 mm diameter increase, within 5 years was analyzed. Among 761 conventional EVAR, 515 patients had >2 years of follow-up. Thirty-three patients with any reintervention within 12 months and 127 patients without CECT at either 6 or 12 months were excluded. Among 131 patients with persistent isolated T2ELs, 74 patients with DD1Y data were enrolled. During a 37 month median follow-up [25–60, IQR], 24 AnEs were observed. In the AnE patients, the median DD1Y was significantly higher than that in the other patients (12.30 [6.88–21.90] vs 7.62 [4.41–13.00], P=0.024). ROC curve analysis indicated that the optimal cutoff point of DD1Y for AnE was 5.5 µg/mL (AUC=0.681). In univariate analysis, angulated neck, occlusion of the inferior mesenteric artery, and DD1Y≥5.5 µg/mL were significantly associated with AnE (P= 0.037, 0.038, and 0.010). Cox regression analysis revealed that DD1Y≥5.5 µg/mL was correlated with AnE (P=0.042, HR [95% CI] 4.520 [1.056–19.349]). Conclusion: A 1 year higher D-dimer level can potentially predict AnE within 5 years in persistent T2EL patients. AnE was considered improbable when the D-dimer level was low enough. Clinical Impact: The present study suggests that a 1-year higher D-dimer level could potentially predict aneurysm expansion within 5 years in patients with persistent type 2 endoleak (T2EL). On the other hand, aneurysm expansion was considered unlikely if the D-dimer level was low enough. As there are many patients with T2EL who require regular follow-up, any predictor of future aneurysm expansion could be of great help in conserving medical resources. In patients with a low likelihood of future expansion, we might consider delaying follow-up, similar to patients with sac shrinkage.

DOI： 10.1177/15266028231170165

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Scopus

PubMed

Language：English   Publisher：Annals of Vascular Surgery  

Background: Significant sac shrinkage after endovascular aortic aneurysm repair (EVAR) is generally considered a positive outcome indicative of durable clinical success. However, its impact on endograft configuration is rarely addressed. Sac remodeling and volume loss due to shrinkage can potentially cause deformation of endograft components, resulting in limb angulation and compression. We investigated the hypothesis that significant sac shrinkage could affect endograft tortuosity at 5 years post-EVAR. Methods: We retrospectively reviewed patients who underwent elective EVAR for infrarenal abdominal aortic aneurysm between June 2007 and December 2018. Patients with early postoperative and 5-year follow-up computed tomography images were included. Patients treated with modular bifurcated endografts (Zenith, Endurant, Excluder, and Incraft) were analyzed. The “shrinkage” group comprised patients with >10 mm diameter reduction, while the “stable” group had ± 5 mm diameter change at 5 years. Tortuosity index (TI) was calculated as the ratio of centerline distance to straight-line distance between proximal and distal endograft edges. The association between sac shrinkage and ≥5% increase of TI (≥5%ΔTI) was analyzed for both ipsilateral and contralateral sides. Results: Of 136 patients enrolled, 80 were in the shrinkage group and 56 in the stable group. On the ipsilateral side, ≥5%ΔTI was observed in 24 cases (17.6%). The patients with ipsilateral ≥5%ΔTI had significantly shorter median neck lengths (22 mm vs. 30 mm, P = 0.030). Sac shrinkage ≥15 mm was negatively associated with ≥5%ΔTI compared to stable sac (P = 0.027). Logistic regression showing sac shrinkage ≥15 mm had a significant negative correlation with ≥5%ΔTI (P = 0.025, hazard ratio [95% confidence interval]: 0.218 [0.057–0.824]). On the contralateral side, ≥5%ΔTI (19 cases, 14.0%) was associated with shorter neck length but not with sac shrinkage. In the shrinkage group, cross-leg positioning resulted in a significant increase in ipsilateral TI at 5 years compared to straight positioning (median ΔTI: 1.8% vs. 0.0%, P = 0.013). No reinterventions for leg-related events were necessary during the 5-year follow-up period. Conclusions: Contrary to our initial hypothesis, significant sac shrinkage does not adversely affect endograft configuration and may help stabilize tortuosity on the ipsilateral side. However, in patients with crossed-leg configuration, continued vigilant observation may be warranted even after achieving sac shrinkage, as it could exacerbate tortuosity. Shorter neck length was associated with increased tortuosity on both sides. Further research is needed to confirm these findings and consider potential confounding factors, including the impact of different endograft designs.

DOI： 10.1016/j.avsg.2024.08.033

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PubMed

Language：English   Publisher：The Editorial Committee of Annals of Vascular Diseases  

<p><b>Objectives:</b> Acute hemorrhagic rectal ulcer (AHRU) occurs with a sudden onset of painless bloody stools and is caused by impaired blood flow in the rectal mucosa due to arteriosclerosis or prolonged bedridden status. Little information is available about AHRU in patients with chronic limb-threatening ischemia (CLTI). This study aimed to identify factors related to AHRU among CLTI patients after bypass surgery.</p><p><b>Methods:</b> Between 2019 and 2023, we enrolled 80 CLTI patients at our institution who underwent bypass surgery using autogenous veins. Data were collected prospectively and supplemented with retrospective medical record reviews. Information regarding demographic and clinical characteristics was collected. The outcomes of patients without AHRU (non-AHRU group) and those with AHRU (AHRU group) were compared. Logistic regression analysis was used to assess factors associated with AHRU after bypass surgery.</p><p><b>Results:</b> During the study period, 6 of the 80 patients (7.5%) experienced AHRU after bypass surgery. There was no significant difference in the global limb anatomic staging system (GLASS) or wound ischemia and foot infection (WIfI) stage between the 2 groups. The percentage of patients taking oral steroids was significantly greater in the AHRU group. In addition, the AHRU group had a significantly greater percentage of postoperative ambulatory failure and a longer hospital stay. In the univariate analysis of factors associated with the incidence of AHRU after bypass surgery, steroid use (odds ratio [OR], 13.8; 95% confidence interval [CI], 2.19–86.9; <i>P</i> = 0.005) and nonambulatory status after surgery (OR, 7.22; 95% CI, 1.26–41.4; <i>P</i> = 0.026) were significant factors.</p><p><b>Conclusions:</b> Steroid use and postoperative nonambulatory status were associated with AHRU after bypass surgery for CLTI.</p>

DOI： 10.3400/avd.oa.24-00125

Open Access

Web of Science

PubMed

CiNii Research

Language：English   Publisher：Journal of Endovascular Therapy  

Purpose: In managing type 2 endoleak (T2EL) following endovascular aortic aneurysm repair (EVAR), an indication for reintervention is aneurysm enlargement (AnE). A previous study found that low D-dimer levels (DDLs) at 1 year were associated with reduced AnE risk in patients with persistent T2ELs (pT2ELs). This study analyzed patients with pT2ELs to determine the correlation between DDLs at annual follow-ups and AnE and proposed a follow-up protocol incorporating DDL monitoring. Methods: A retrospective review of elective EVAR cases between June 2007 and January 2021 identified “persistent” T2EL as confirmed at both 6- and 12-month contrast-enhanced CT studies. “Isolated” T2EL referred to cases without other endoleak types within 12 months. Inclusion criteria comprised >2 years of follow-up, isolated pT2ELs at 1 year, and DDL data at any annual follow-up over 5 years. The association between DDL and AnE, defined as ≥5 mm expansion within 5 years, was analyzed. Results: A total of 109 patients with DDL data at 288 time points were enrolled. During a median follow-up of 49 months [31-60, IQR], 43 AnE were observed. In patients without AnE and with DDL data at 1 and 2 years (N=77 and 56), lower DDLs were associated with a reduced AnE risk (p=0.03 and 0.01). Optimal cutoff points were 5.4 and 5.3 µg/mL (AUC=0.651 and 0.702) with high negative predictive values (86.9% and 93.8%). Cox regression analyses confirmed that DDLs surpassing the cutoff values correlated significantly with AnE (p=0.042 and p=0.038). Our simulated protocol for omitting imaging studies in patients with stable aneurysms and low DDL might have overlooked one AnE but could have saved 28 imaging studies over 3 years if implemented on our patients. Conclusion: Low DDLs at the 1- and 2-year follow-ups can potentially exclude AnE in pT2EL patients, suggesting DDL monitoring as a resource-saving approach. Clinical Impact: The management of type 2 endoleaks in post-EVAR patients has been a topic of debate. This retrospective single-center study, featuring strict inclusion criteria, included 109 patients with persistent type 2 endoleaks. The findings indicate that patients with lower D-dimer levels at 1- and 2-year follow-ups are unlikely to experience sac enlargement ≥5 mm within 5 years, even in the presence of type 2 endoleaks. This study suggests that D-dimer monitoring has the potential to reduce reliance on imaging studies for the follow-up of patients with type 2 endoleaks, leading to significant savings in medical resources.

DOI： 10.1177/15266028241306277

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PubMed

Language：English   Publisher：Journal of Endovascular Therapy  

Purpose: An accurate distal deployment is essential for successful thoracic endovascular aortic repair (TEVAR) of a paradiaphragmatic aortic aneurysm. This study aimed to investigate the anatomical and intraoperative factors that affect the accuracy of distal deployment during TEVAR. Methods: We conducted a retrospective review of preoperative and postoperative computed tomography scans of 426 patients undergoing TEVAR at our institution between October 2008 and May 2021, of which the stent-graft was attempted to be deployed just above the celiac axis or the superior mesenteric artery in 56 patients. Based on the anatomical factors related to the malposition (deployed >10 mm away from the target vessel) and the greater curve to the straight-line ratio (G/S ratio), the patients were categorized as severe tortuosity (n=21) and mild tortuosity (n=35) groups to compare the operative and clinical outcomes. Result: Stent-graft malpositioning occurred in 21 cases. Among all anatomical variables, only the G/S ratio was significantly larger in the malpositioned cases (p=0.049). A cutoff G/S ratio value of 1.15 was determined using the receiver operating curve analysis. In the severe tortuosity group, the distal end of the stent-graft was significantly farther (median: 10.0 [interquartile range (IQR): 2.5–19.5] mm vs 3.0 [0–8.0] mm; p=0.015) from the target vessel, and the tilt angle of the stent-graft’s distal edge was larger (median: 21.4 [IQR: 15.8–24.5] vs 9.5 [5.5–12.5] degree; p<0.01) than that in the mild tortuosity group. Both groups were comparable for the incidence of a primary type Ib endoleak (p=0.454), a secondary type Ib endoleak (p=1.0), and the rate of distal reintervention (p=0.276). Conclusion: Severe tortuosity in the distal descending thoracic aorta is associated with a malpositioned and tilted distal end of the stent-graft. Clinical Impact: Thoracic endovascular aortic repair (TEVAR) for paradiaphragmatic thoracic aortic aneurysms requires accurate distal landing. In this paper, a retrospective CT analysis revealed that the greater curve to the straight-line ratio (G/S ratio) was associated to affects the malposition of the stent graft, defined as being deployed more than 10 mm away from the target vessel. Further, a comparative analysis based on the G/S ratio demonstrated that severe aortic tortuosity was associated with a more distal and tilted deployment of the stent graft.

DOI： 10.1177/15266028221141023

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PubMed

Language：English   Publisher：Nagoya Journal of Medical Science  

We previously reported that spinal cord injury following thoracic endovascular aortic repair for a thoracic aortic aneurysm is a micro embolism caused by a vulnerable mural thrombus. Conversely, patients who underwent thoracic endovascular aortic repair for aortic dissection develop spinal cord injury less frequently due to fewer mural thrombi. Paying attention to preserving blood flow toward the spinal cord, namely collateral circulation and steal phenomenon, prevents spinal cord injury following thoracic endovascular aortic repair for aortic dissection.

DOI： 10.18999/nagjms.86.1.16

Open Access

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Scopus

PubMed

Language：English   Publisher：Vascular  

Purpose: Surgical revascularization is the standard treatment for chronic limb-threatening ischemia (CLTI). However, some patients may require reintervention. The Global Anatomic Staging System (GLASS), which evaluates the complexity of infrainguinal lesions, was proposed. This study aimed to identify predictors for graft revision and evaluate whether GLASS impacts vein graft revision. Methods: Between 2011 and 2018, CLTI patients who underwent de novo infrapopliteal bypass using autogenous veins were retrospectively analyzed. To assess anatomic complexity with GLASS, femoropopliteal, infrapopliteal, and inframalleolar/pedal (IM) disease grades were determined. The outcomes of patients with or without graft revision were compared. Cox regression analysis was performed. Results: Thirty-six of the 80 patients underwent reintervention for graft revision. Compared to the non–graft revision group, the graft revision group exhibited significantly higher rates of GLASS stage III (66% vs 81%, p = 0.046) and grade P2 IM disease (25% vs 58%, p = 0.009). Multivariate analysis revealed that IM grade P2 (hazard ratio [HR], 3.35; 95% confidence interval [CI], 1.66–6.75; p = 0.001) and spliced vein grafts (HR, 3.18; 95% CI, 1.43–7.06; p = 0.005) were significantly associated with graft revision. Conclusions: This study demonstrated that IM grade P2 and spliced vein grafts were predictors of graft revision. The GLASS stratification of IM disease grade may be useful in optimizing treatment for CLTI.

DOI： 10.1177/17085381221124706

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PubMed

Language：English   Publisher：Annals of Vascular Surgery  

Background: Patients with malignancy are at high risk of venous thromboembolism, and early diagnosis is important. The Khorana score is known as a risk assessment for cancer-related thrombosis during chemotherapy, but there are still few reports on its diagnostic potential, the optimal D-dimer cutoff values for indications other than chemotherapy and the use of the Khorana score in combination with D-dimers. In this study, we examined the clinical appropriateness of increasing the D-dimer cutoff value. Methods: We retrospectively studied 208 malignancies out of 556 patients who underwent lower extremity venous ultrasonography at our hospital over a 2-year period from January 2018 to December 2019. The optimal D-dimer cutoff value for predicting deep vein thrombosis (DVT) in patients with malignancy was calculated by the Youden index. The usefulness of the Khorana score alone and the model combining the Khorana score with D-dimer for predicting DVT diagnosis was compared using receiver operating characteristic analysis. Results: Of 208 eligible patients, 59 (28.4%) had confirmed DVT. The optimal D-dimer cutoff value for predicting DVT comorbidity in patients with malignancy was 3.96 μg/mL. When the new D-dimer cutoff value was set at 4.0 μg/mL, the odds ratio (OR) for DVT diagnosis was 4.23 (95% confidence interval (CI) 2.10–8.55, P < 0.001), which was higher than the OR of 1.33 (95% CI: 0.98–1.81, P = 0.064) for the Khorana score. The area under the curve for the Khorana score and D-dimer was 0.714, which was significantly higher than the 0.611 for the Khorana score alone, with the difference being significantly higher at 0.103 (P = 0.004, 95% CI: 0.033–0.173). Conclusions: The optimal D-dimer cutoff value for the diagnosis of DVT in patients with malignancy was 4.0 μg/mL. It was also suggested that the combination of the Khorana score with the D-dimer level was more accurate in diagnosing DVT than the Khorana score alone.

DOI： 10.1016/j.avsg.2023.06.033

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Endovascular Therapy  

Purpose: Despite controversy surrounding the management of type 2 endoleaks (T2ELs) after endovascular aortic aneurysm repair (EVAR), the current European guidelines recommend reintervention for T2ELs when the aneurysm expands by ≥10 mm. Meanwhile, sac shrinkage ≥10 mm can be considered low risk for failure even with T2ELs, and the guidelines suggest less frequent follow-up delayed until 5 years after EVAR. This study reviewed patients with persistent T2ELs to identify predictors of spontaneous sac shrinkage (SpS) within 5 years. Methods: A retrospective review of elective EVAR for infrarenal aortic aneurysms between June 2007 and December 2017. Patients with >1 year follow-up and persistent T2ELs, defined as T2ELs confirmed at both the 6 and 12 month follow-up with contrast-enhanced computed tomography (CT), were included. Any reintervention or type 1 or 3 endoleaks within 12 months were excluded. SpS was defined as a ≥10 mm reduction in diameter without any reintervention. Aneurysm enlargement (AnE) was defined as a ≥5 mm increase in diameter. Factors associated with SpS within 5 years were analyzed. The clinical outcomes were reviewed. Results: Among 726 patients, 162 patients had persistent isolated T2ELs. After excluding 21 patients, 141 patients were enrolled. During a median follow-up of 43 months (interquartile range [IQR], 26–60), 28 SpS and 39 AnE were observed, and 31 reinterventions were performed. The cumulative rates of SpS were 14.2%±2.9% and 25.6%±5.1% at 1 and 5 years. Cox regression analysis revealed that the presence of ≥6 patent lumbar arteries had a significant negative correlation with SpS (p=0.036). During further follow-up after SpS, 2 reinterventions for type 1a and 3b endoleaks were required at 49 and 45 months. Conclusions: Patients with fewer patent lumbar arteries were likely to experience SpS within 5 years, even in the presence of persistent T2ELs. Follow-up imaging studies were advisable earlier than 5 years, even after SpS.

DOI： 10.1177/15266028221083457

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PubMed

Language：Japanese   Publisher：Japanese College of Angiology  

<p>We have previously reported that spinal cord injury (SCI) after TEVAR for thoracic aortic aneurysm (TAA) is a micro embolism due to a vulnerable mural thrombus. Conversely, TEVAR in patients with aortic dissection (AD) develops SCI less frequently because of fewer mural thrombi. To prevent SCI after TEVAR for AD, attention should be paid to preserving blood flow towards the spinal cord, such as collateral circulation and steal phenomenon.</p>

DOI： 10.7133/jca.23-00001

Open Access

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jvs.2022.08.017

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Scopus

PubMed

CiNii Research

Language：English   Publisher：Journal of Vascular Surgery  

Background: The epicardial adipose tissue volume (EATV) is associated with cardiovascular diseases such as coronary artery disease. However, no information is available regarding the relationship between the EATV and abdominal aortic aneurysm (AAA) expansion. In the present study, we evaluated the association between the EATV and AAA growth and sought to identify the predictors of AAA expansion. Methods: Between June 2009 and December 2019, 906 patients had undergone endovascular or open repair of AAAs at our institution. Patients with previous cardiac surgery, previous ascending thoracic aortic surgery, a ruptured AAA, an infected AAA, an inflammatory AAA, a saccular aneurysm, a solitary iliac aneurysm, or reintervention after treatment of the AAA were excluded. A total of 237 patients with at least two preoperative computed tomography (CT) scans performed >180 days apart were included in the present study. The EATV within the pericardium was retrospectively quantified from the preoperative non–contrast-enhanced CT images using a three-dimensional workstation. The EATV index was defined as the EATV divided by the body surface area. The AAA expansion rate was defined as an increase in the AAA diameter annually, and the patients were divided into the slow-expansion group (expansion rate, <5 mm/y) and the fast-expansion group (expansion rate, ≥5 mm/y). The correlation between the expansion rate and the EATV index was analyzed, and the cutoff value for the EATV index was determined using a receiver operating characteristics curve. Multivariate analysis was used to assess the predictors of the AAA expansion rate. Results: The expansion rate of AAA correlated positively with the EATV index (R = 0.237; P < .001). The initial aneurysm diameter (P < .001) and EATV index (P = .009) differed significantly between the two groups. The cutoff for the EATV index was 60.3 cm³/m² (area under the curve, 0.658; 95% confidence interval [CI], 0.568–0.749; sensitivity, 1.000; specificity, 0.309). Multivariate analysis revealed that the initial aneurysm diameter and an EATV index of >60.3 cm³/m² were significantly associated with the AAA expansion rate. Conclusions: The results of the present study have demonstrated that the EATV index is associated with AAA expansion.

DOI： 10.1016/j.jvs.2022.04.032

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PubMed

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Zinc (Zn) has been reported to play an important role in wound healing (WH). Nevertheless, the effect of Zn in chronic limb-threatening ischemia (CLTI) patients is unclear. This study investigated the effect of Zn on the clinical outcomes of CLTI patients undergoing bypass surgery.</p><p><b><i>Methods and Results:</i></b> This study reviewed 111 consecutive patients who underwent an infrainguinal bypass from 2012 to 2020. Patients with Zn deficiency (serum Zn level <60 μg/dL) received oral Zn supplementation and maintained a normal level until WH. This study aimed to explore: (1) the effect of Zn deficiency; and (2) Zn supplementation in Zn-deficient patients on the clinical outcomes of this cohort. Patients with Zn deficiency, Zn supplementation, and no Zn supplementation despite Zn deficiency accounted for 48, 21, and 42 patients, respectively. (1) Zn deficiency was associated with WH (HR, 0.47; 95% CI, 0.29–0.78: P=0.003), major adverse limb events (MALE) (HR, 2.53; 95% CI, 1.26–5.09: P=0.009), and major amputation or death (HR, 3.17; 95% CI, 1.51–6.63: P=0.002). (2) Zn supplementation was positively related to WH (HR, 2.30; 95% CI, 1.21–4.34: P=0.011). This result was confirmed using propensity score matching (HR, 2.24; 95% CI, 1.02–4.87: P=0.043).</p><p><b><i>Conclusions:</i></b> The current study revealed that Zn level was associated with clinical outcomes in CLTI patients after bypass surgery. Oral Zn supplementation could improve WH in these patients.</p>

DOI： 10.1253/circj.cj-21-0832

Open Access

Web of Science

Scopus

PubMed

CiNii Research

Language：English   Publisher：Annals of Vascular Surgery  

Background: Although we have witnessed several cases of late proximal type I endoleak (T1AEL) after endovascular aneurysm repair (EVAR), most patients did not have “hostile neck” preoperatively. We hypothesized that the distance between the lowest renal artery and the neck angulation point and neck length are the 2 most important factors for maintaining long-term proximal sealing. This study evaluated “neck hostility,” which is the product of the distance to the angulation point and the neck length, as a preoperative morphological risk factor for the development of late T1AEL after EVAR. Methods: A retrospective review of a prospectively assembled database was performed for all patients who had undergone EVAR at a single institution from June 2007 to May 2017. Patient demographics and preoperative imaging data were collected, and Cox regression analysis was performed to identify the risk factors for late T1AEL. Results: Of the 655 patients who underwent EVAR during the study period, 115 were excluded due to complex EVAR (n = 14), primary indications for iliac aneurysms (n = 86), primary T1AEL (n = 3), or other reasons (n = 15). Of the remaining 537 patients, twelve patients (2.2%) developed late T1AEL a median of 3.2 (interquartile range [IQR]; 3.0, 5.4) years after EVAR. Receiver operating characteristic (ROC) curve analysis revealed a neck hostility cutoff value of 8. Cox regression analysis revealed that a neck hostility value ≤8 and conical neck anatomy were risk factors for the development of late T1AEL after EVAR. Well-known hostile neck factors such as short neck, severe angulated neck, and severe calcification/thrombus in the proximal neck were not significantly different. Conclusions: The present study demonstrated a correlation between late T1AEL and the product of the angulation distance and the neck length. This factor may be useful for predicting poor late proximal outcomes after EVAR.

DOI： 10.1016/j.avsg.2021.09.049

Open Access

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PubMed

Language：English   Publishing type：Doctoral thesis  

DOI： 10.1007/s00595-021-02362-x

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PubMed

Event date： 2023.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Event date： 2023.3

Language：English   Presentation type：Symposium, workshop panel (nominated)  

Event date： 2023.3

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Event date： 2023.3

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Country：Japan  

Event date： 2022.12

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Event date： 2022.9

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Event date： 2022.6

Language：English   Presentation type：Oral presentation (general)  

Event date： 2022.5

Language：English   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2022.3

Language：Japanese   Presentation type：Oral presentation (general)