Prognostic significance of large diameter proximal aortic neck in endovascular aneurysm repair

Summary. Background: Adverse morphological features of the proximal aortic neck have been identified as culprits for late failure after endovascular aneurysm repair (EVAR). Our objective was to investigate the prognostic role of wide proximal aortic neck in EVAR. Methods: We conducted a review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies comparing outcomes of EVAR in patients with large versus small proximal aortic neck. A meta-analysis of time-to-event data was performed with the inverse-variance method and the results were reported as summary hazard ratio (HR) and 95 % CI. We applied random-effects models of meta-analysis. Results: We identified 9 observational studies reporting on a total of 7,682 patients (1,961 with large diameter and 5,721 with small diameter neck). The hazard of death (HR 1.57, 95 % CI 1.23–2.01; P = 0.0003), aneurysm-related reintervention (HR 2.06, 95 % CI 1.23–3.45; P = 0.006), type Ia endoleak (HR 6.69, 95 % CI 4.39–10.20; P < 0.001), sac expansion (HR 10.07, 95 % CI 1.80–56.53; P = 0.009), aneurysm rupture (HR 2.96, 95 % CI 2.00–4.38; P < 0.0001), and neck-related adverse events (HR 10.33, 95 % CI 4.95–21.56; P < 0.0001) was higher in patients with large diameter proximal aortic neck than in those with small neck. Conclusions: Patients with a large proximal aortic neck were found to have poorer outcomes than those with small neck. This finding has implications in decision making when selecting methods for aneurysm treatment and in EVAR surveillance for aneurysm-related complications in this cohort of patients.