This document discusses expanding the use of endovascular aneurysm repair (EVAR) to treat abdominal aortic aneurysms in patients who have anatomical challenges, such as short neck lengths. It provides an overview of studies demonstrating the effectiveness of EVAR. The document then focuses on the presenter's experience at Istanbul University treating 48 patients with neck lengths between 10-15mm using the Endurant stent graft. It reports no instances of early or late rupture or conversion to open surgery in these off-label cases, with only one reintervention needed after 2 years of follow-up. The document also briefly discusses chimney EVAR and fenestrated/branched EVAR as other techniques to expand EVAR to challenging anatom

1. THE HOSTILE NECK: ANATOMICALTHE HOSTILE NECK: ANATOMICAL
LIMITS AND FAR: ISTANBULLIMITS AND FAR: ISTANBUL
MEDICAL FACULTY EXPERIENCEMEDICAL FACULTY EXPERIENCE
Dr. Onur GÖKSELDr. Onur GÖKSEL
IstanbulIstanbul University, Istanbul Medical FacultyUniversity, Istanbul Medical Faculty
Department of Cardiovascular SurgeryDepartment of Cardiovascular Surgery

2. DISCLOSURESDISCLOSURES
 I do not have any potential conflictI do not have any potential conflictss ofof
interestinterest

3.  The clinical effectiveness of EVAR is wellThe clinical effectiveness of EVAR is well
established (EVAR 1, DREAM, EVAR 2,established (EVAR 1, DREAM, EVAR 2,
Eurostar, etc.)Eurostar, etc.)
 The primary concerns that remain includeThe primary concerns that remain include
-Durability over the long-term-Durability over the long-term
--Performance outside of controlled trialsPerformance outside of controlled trials
whenwhen anatomical limits extendedanatomical limits extended

7. EVAR eligibility by neck lengthEVAR eligibility by neck length

10. 2013 CONSENSUS2013 CONSENSUS

11. The Current IFU’sThe Current IFU’s

12. Anatomical ChallengesAnatomical Challenges

15. Access site/Main body deployment sideAccess site/Main body deployment side

16. Endurant designed forEndurant designed for
challenging neckschallenging necks

25. 1st and 2nd year data1st and 2nd year data

27. 2008-20132008-2013
 48 patients with necks 10-15mm48 patients with necks 10-15mm
 47 pts with Endurant47 pts with Endurant
 1 Patient with Ovation1 Patient with Ovation
 29±17 months of followup29±17 months of followup
 No early/late rupturesNo early/late ruptures

28. 47 Pts w/ 10-15 mm Neck47 Pts w/ 10-15 mm Neck
2008-20132008-2013
Immediate/
Early
6th Mo 12 mo 24 mo
Type I
Endoleak
2 (4%) 1 (2%) 0 0
Rupture 0 0 0 0
Conversion 0 0 0 0
Reintervention 0 0 0 1 (2%)
Procedure
Related
Complication
0 0 0 1(Limb
seperation)
(2%)
Mortality 0 0 0 0

31. Lennox et al. EJVES 2010

32. Expanded Indications of Chimney EVAR in rAAAExpanded Indications of Chimney EVAR in rAAA

37. Tips & Pitfalls in ChimneyTips & Pitfalls in Chimney
EVAREVAR

40. Lobato et al. JVS 2012;56:285.Lobato et al. JVS 2012;56:285.

41. Fenestrated /Branched EVARFenestrated /Branched EVAR