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Ann Thorac Cardiovasc Surg. 2014;20(1):61-6. Epub 2013 Feb 15.

Outcomes following endovascular abdominal aortic aneurysm repair both within and outside of the instructions for use.

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Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.



To determine the influence of the abdominal aortic aneurysm (AAA) anatomy on the clinical outcomes after endovascular AAA repair (EVAR).


Between January 2008 and December 2010, 53 patients underwent EVAR. The parameters outside of the device instructions for use (IFU) were: short neck length (<15 mm), proximal neck angulation (>60 degrees), small diameter of external iliac artery (<7 mm) and bilateral internal iliac embolization.


A total of 37% of these grafts were placed outside of at least one IFU parameter. The intraoperative problems encountered included one (3%) acute graft limb thrombosis, and one (3%) access vessel rupture within the IFU (w-IFU) group. One perioperative mortal case was observed in the w-IFU group due to thoracic aortic dissection. After one year follow-up, type II endoleak (EL) was recognized in 8 of 28 (29%) patients in the w-IFU group, and in 2 of 12 (17%) patients outside of the IFU (o-IFU) group. There was also no significant difference of early and mid-term outcomes between favorable neck anatomy and hostile neck anatomy (HNA).


In our series, EVAR provided acceptable results even in the o-IFU group and HNA. This suggests that the IFU can be extended to other selected patients.

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