Mid-term Outcomes of Open Repair for “Wide-Neck” Abdominal Aortic Aneurysms

The aim of this study is to report mid-term clinical and morphologic outcomes after open abdominal aortic aneurysm (AAA) repair with wide (≥28 mm) infrarenal neck (WN). Patients undergoing open repair for WN AAA at a single center between 2009 and 2014 were prospectively collected and retrospectively analyzed. Aortic neck was measured at 1 cm below the lowermost renal artery. Primary endpoint was juxta/suprarenal aortic diameter enlargement needing reintervention. Secondary endpoints were mid-term freedom from reintervention (FFR), overall survival, and AAA-related mortality. Aortic diameters were measured preoperatively (T0) and at 5 years (T1) on three-dimensional workstation center-line reconstructions, at the level of aortic anastomosis, at the level of each renal artery and at the superior mesenteric artery. Preoperative (T0) and latest follow-up (T1) aortic diameters were compared by paired t-test. During the study period, 1340 AAA open repairs were performed. Seventy patients (5.22%) had a WN AAA (mean age, 69.8 ± 7.2 years), with a mean WN AAA diameter of 30.5 ± 2.7 mm. Mean total operative time and mean aortic clamping time were 141 ± 40 minutes (range, 70-300 minutes) and 43 ± 12 minutes (range, 20-74 minutes), respectively. The mean follow-up was 78.4 ± 35.6 months (range, 6-137 months). Twelve patients (17.4%) were lost during follow-up. During follow-up, AAA-related reinterventions were performed, with a FFR rate of 92.8%. At 5 years, the overall mortality was 21.7% (15/69), with one AAA-related death (1/69; 1.4%). Pre- and postoperative CT scans were available on 46 patients, observing a significant reduction of the aortic diameter below the lowest renal artery (30.5 vs 27.8 mm; P < .001). Open repair performed in WN AAA is technically demanding. However, mid-term outcomes showed no significant aortic neck enlargement and a reduction of the aortic diameter below the lowest renal artery.