December 18, 2019
Outcomes Compared With Terumo Aortic’s Treovance EVAR Stent Graft for Favorable Versus Hostile Neck Angulation
December 18, 2019—David Murray, MD, et al conducted a study to compare outcomes of patients with favorable neck angulation (FNA) versus hostile neck angulation (HNA) treated with the Treovance stent graft (Terumo Aortic, formerly Bolton Medical). The investigators published the results online ahead of print in Journal of Vascular Surgery (JVS).
The study was composed of patients with abdominal aortic aneurysms suitable for endovascular repair with the Treovance device, who were included in the RATIONALE postmarket surveillance registry. This post hoc subgroup analysis compared patients with infrarenal neck angles < 60º (FNA) and ≥ 60º (HNA).
As summarized in JVS, the investigators analyzed 179 FNA (89.5%) and 21 HNA (10.5%) patients after 1 year. Both groups were similar in terms of sex (male, 92.7% FNA and 95.2% HNA) and age (73 years vs 72.6 years), but the HNA group had more Asian or other race representation (7.3% vs 19%) and more patients assigned to American Society of Anesthesiologists class 3 and 4 (57.6% vs 66.7%).
Mean suprarenal angles ± standard deviation were 13.1º ± 13.5º (FNA) versus 29º ± 16.4º (HNA); mean infrarenal angles were 23.2º ± 16.4º (FNA) versus 65.4º ± 4.6º (HNA). Aneurysm sac size maximum diameter was 58.1 ± 9.8 mm versus 62 ± 14.1 mm.
The investigators found that there was a significant difference in unplanned adjunctive procedures (2.2% vs 19%; P = .01). Mean procedural duration was also significantly different for HNA patients, who underwent protracted operations (111.3 ± 47.3 minutes vs 153.5 ± 44.5 minutes; P < .0001). However, there were no significant differences in rates of clinical success (96.1% vs 95.2%). The rate of reintervention was low overall but 0% in the HNA group. Changes in sac size at 1 year were significant in both groups but not as pronounced in HNA patients (relative change of −11.8% ± 13.3% vs −6.6% ± 11.4%).
Patients with greater neck angulation treated with Treovance underwent more complex procedures but showed equally good technical success and 1-year clinical success parameters, concluded the investigators in JVS.