Experience With the Endologix Powerlink Endograft in Endovascular Repair of Abdominal Aortic Aneurysms With Short and Angulated Necks

Abstract

Endovascular aortic aneurysm repair (EVAR) for anatomically suitable abdominal aortic aneurysms (AAAs) has gained wide acceptance in the past decade, and EVAR for anatomically challenging or unsuitable AAAs such as short and angulated neck AAAs has become a hotly debated subject. The objective of this study is to summarize the unique experience of EVAR for short / angulated neck AAAs with Powerlink unibody bifurcated stent-graft. Data were retrospectively analyzed from 519 patients in our single unit from February 1999 to December 2007 who underwent EVAR using the Powerlink endograft, and had short or angulated necks. Short neck was defined as < or = 15 mm for the infrarenal neck length, and it was divided into 2 groups: Group A (short neck), 54 cases with the length 11 to 15 mm; and Group B (very short neck), 26 cases with the length < or = 10 mm. Angulated neck of 37 cases which was defined as > or = 60 degrees angulation between the longitudinal axis of infrarenal aorta and the aneurysm. The unique strategy of treating short / angulated neck AAAs is to build up the endoluminal exclusion system from the native aortic bifurcation to the renal artery level with suprarenal fixation. The Powerlink unibody bifurcated stent graft was implanted anatomically fixed on the aortic bifurcation and a long suprarenal cuff was built up to the renal arteries. A Palmaz stent can be used for proximal fixation and sealing enhancement in the most challenging necks. The follow-up imaging was performed at 1 month, 6 months, and yearly thereafter. The technical success rate was 97.4% (114/117). Intraoperative complications included 3 conversions due to delivery access problems, 6 proximal type I endoleaks, and 5 type II endoleaks. The 30-day mortality was 1.7% (2/117). The 2.6-year follow-up showed 4 (3.4%) proximal type I endoleaks, which were revised with proximal cuff and/or Palmaz stent. Limb occlusion occurred in 2 cases, and the total re-intervention rate was 5.3%. Three (2.6%) type II endoleaks were left in observation. There were 3 (2.6%) partial renal infarctions, no stent-graft distal migration, and no post-EVAR ruptures. Our experience demonstrates that building up the endoluminal exclusion system from the abdominal aortic bifurcation to the renal artery level using the Powerlink fully supported unibody bifurcated stent-graft with a long suprarenal cuff, and a Palmaz stent when needed, proved safe and effective in treating AAAs with short and angulated necks.