Anatomic and clinical characterization of the narrow distal aorta and implications after endovascular aneurysm repair

Abstract Objective The purpose of this analysis was to compare 1-year clinical outcomes after endovascular repair of abdominal aortic aneurysms with the EXCLUDER device in patients with standard and narrow aortic bifurcations (AOBs). Methods Data were prospectively collected from a 1055-participant subset of the multicenter Global Registry for Endovascular Aortic Treatment (GREAT) treated for abdominal aortic aneurysm repair between August 2010 and September 2015. There were 117 patients with a narrow AOB (NB; defined as  Results The mean distal aortic neck diameter was 12.4 mm in the NB cohort and 25.3 mm in the SB cohort ( P P P  = .004) and with more severe comorbidity burden. There was a significantly higher rate of surgical cutdown access in the NB cohort ( P P  = .02). The 1-year freedom from mortality was estimated as 92.1% in the SB cohort and 99.1% in the NB cohort. Freedom from reintervention was estimated as 95.1% in the SB cohort and 92.8% in the NB cohort at 1 year. Through 1-year follow-up, 24 SB patients (2.6%) and 4 NB patients (3.4%) exhibited an endoleak requiring reintervention ( P  > .99). Type II endoleaks represented 72% and 60% of treated endoleaks, respectively. Through 1 year, 10 SB patients (1.0%) and 2 NB patients (1.7%) exhibited occlusive/thrombotic events ( P  = .54). There were no reported instances of kinking, migration, fracture, compression, or dissection through 1 year in either cohort. One SB patient experienced thoracic aortic aneurysm rupture. Conclusions The 1-year outcomes after endovascular aneurysm repair with the EXCLUDER device were comparable in the NB and SB cohorts. A narrow AOB was not found to be associated with a higher incidence of later limb occlusions or endoleaks. Female patients were disproportionately more likely to have a narrow AOB, which correlated with narrowed proximal necks and access vessels, and a more severe comorbidity burden.