Midterm Outcomes for Funnel-EVAR

TL;DR

Funnel-EVAR is a safe and effective treatment for patients with wide aortic necks, showing good midterm outcomes.

Contribution

Demonstrates the effectiveness of Funnel-EVAR for wide aortic necks using a 60 mm thoracic endograft in frail patients.

Findings

No early mortality and 100% technical success with Funnel-EVAR in 22 patients.

No endoleaks, migration, or aneurysm sac enlargement observed during 32.8-month follow-up.

Three patient deaths occurred, but none were aneurysm-related.

Abstract

The funnel technique, the hybrid assembly of a thoracic and
abdominal aortic endograft, is advantageous for frail patients where efficient
oversizing is not possible for infrarenal wide aortic necks over 34 mm. We sought
to determine the advantages and disadvantages of the Funnel-endovascular aneurysm
repair (EVAR) technique using 60 mm length thoracic endograft.

This retrospective study included 22 patients, all frail with high comorbidities,
who were operated on with the Funnel technique using the 60 mm Lifetech Ankura
thoracic endograft, in 7 urgent and 15 elective cases from January 2018. There
were no exclusion criteria except having an age <60 years. Primary endpoints
were the technical success and early mortality and morbidity; secondary endpoints
were late outcomes such as endoleak, migration, late open surgical conversion,
successful sac shrinkage, and enlargement at the infrarenal aortic neck diameter.

The patients’ mean age was 72.6 ± 7.3 years (62–86
years), with a mean aneurysm diameter of 83.2 ± 16.8 mm and mean infrarenal
aortic diameter of 38.7 ± 2.4 mm. There was no early mortality. Technical
success was 100%. 21 standard bifurcated and one aorto-uni-iliac abdominal
endograft were deployed. The mean fluoroscopy time was 14.3 ± 5.2 minutes.
Mean follow-up was 32.8 ± 19.6 months, with no endovascular complications.
There was no Type-1a or Type-3 endoleak, migration, infrarenal aortic neck
diameter enlargement, or aneurysm sac enlargement. During the follow-up, three
patients died, but there was no aneurysm-related mortality.

Funnel-EVAR is effective and safe for patients with a wide infrarenal aortic neck
diameter when assessing midterm outcomes. Therefore, it should be part of the
armamentarium of a vascular surgeon in patients with wide aortic necks >34 mm.

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