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Aim. The aim of this paper was to report the results of a multicenter study on endovascular repair of abdominal aortic aneurysms (AAA) in patients with important angulation of proximal neck using a flexible stent-graft (Aorfix).
Methods. Endovascular repair of AAA using a flexible stent-graft was performed at 16 centers in 29 patients with angulation of proximal neck greater than 45 degrees. Twenty-three patients (79%) had angulation greater than 60 degrees and were therefore contraindicated for repair with other contemporary devices.
Results. Technical success was achieved in all but one case (96%). There was one postoperative death due to multiorgan failure following revision of groin wound for hemorrhage. No patients were converted to open repair. One patient had persisting proximal endoleak despite placement of proximal extension. One patient in whom wireform fractures had been detected died from ruptured aneurysm at nearly 4 year follow-up.
Conclusion. Endovascular repair using a flexible stent-graft is feasible in patients with highly angulated necks. This flexible stent-graft allows the possibiity of a repair for patients unsutable for the currently available commercial grafts. Mid-term results are acceptable and need to be confirmed by longer follow-up and larger series.
KEY WORDS: Aortic aneurysm, abdominal - Aorfix stent-graft Endovascular surgical procedures.
Severe angulation at the proximal aneurysm neck is recognized as an important risk factor of failure of endovascular repair of abdominal aortic aneurysms (EVAR).1 Angulation increases difficulty in delivery system introduction and stent-graft deployment. Analysis of preoperative CT-scan showed that neck angulation increased the risk of type I endoleak.2 Bench-test studies confirmed this hypothesis and identified stent-graft stiffness as a cause of failure of the seal.3 A program supported by a UK MedLink grant was started to design and manufacture a flexible stentgraft able to overcome these issues. This program led to the development of the Aorfix stent-graft (Lombard Medical, Didcot, UK). Further bench-test studies suggested greater efficiency in terms of seal when using a flexible stent-graft instead of other commercially available stent-grafts.4 After preclinical evaluation of the stent-graft was performed and satisfactory results obtained, clinical trial began in 2002 with satisfactory preliminary results.5 The aim of the present study was to assess the results of EVAR using the Aorfix stent-graft in patients with angulation of the proximal neck equal...