Abstract No. 356: Pain in the neck: Dealing with hostile neck anatomy during endovascular repair of AAA

Abstract

1) To understand the barriers to effective proximal seal during EVAR. 2) to understand the problems encountered with hostile neck anatomy. 3) to understand the techniques described in managing hostile neck anatomy: a) Fenestrated grafts, b) balloon expandable stents, c) aortic cuffs, d) renal stents, e) fenestrated grafts. 4) to review new endograft devices that may help in the management of hostile neck anatomy. The advent of endovascular repair of abdominal aortic aneurysm (AAA), has had a profound impact on the way patients are treated. As technology and techniques improve, more and more patients are treated by this modality. Successful endovascular repair depends highly upon effective “seal” at normal vessels above the aneurysm. Many various technqiues ranging from extra pieces to different types of primary devices will be shown in this exhibit. Various attributes of the proximal seal zone have been described as “hostile neck anatomy”. We will review the literature with regards to defining hostile neck anatomy and their outcomes with EVAR. With this understanding, various techniques, which we describe here, are used in obtaining and maintaining effective seal in patients with hostile neck anatomy. We use examples and review our internal follow-up results over a 5 year period which includes over 30 cases. Using sophisticated imaging and interventional skills, some patients with hostile neck anatomy (outside of IFU) may be treated successfully with complex adjunctive techniques.