Suitability of EVAR with Hostile Neck

Abstract
Background: Endovascular treatment of abdominal aortic aneurysms (EVAR) is now considered first line of treatment for abdominal aortic aneurysm (AAA) mainly due to the lower morbidity and mortality, hostile neck is a major obstacle in treating such patients, however many endovascular methods are available to overcome such obstacle, EVAR out of IFU is considered one of the lines of management. Further evaluation is needed.
Aim of Study: Aim of this study was to evaluate the effectiveness of endovascular treatment of AAA with hostile neck anatomy, with commenting on the perioperative compli-cations, mortality and morbidity.
Material and Methods: This study was done retrospectively over a period of 18 months including 10 patients who had endovascular treatment of abdominal aortic aneurysms with hostile neck anatomy.
Results: 10 patients were included in this study primary technical success was achieved in 90% of cases while the last case needed aortic cuff as an adjunctive procedure. One case required re-intervention within 30 days post-operative due to limb graft occlusion, managed by femoro-femoral bypass. At one year follow up mortality was 10%.
Conclusion: EVAR for AAA patients with HNA is feasible; patients with single feature of HNA showed the best outcome, while patients with more than one feature required the usage of adjunctive techniques for proximal sealing and were more liable to develop post-operative complications.