Long-Term Outcomes of the Aorfix™ Stent Graft in Japanese Patients with Severely Angulated Aortic Necks: A Single-Center Retrospective Study.

Background/Objective: Endovascular aneurysm repair (EVAR) using Aorfix (Lombard Medical, Inc., Irvine, CA, USA)TM has shown excellent outcomes, even in cases of abdominal aortic aneurysm with highly angulated aortic necks (≥60°). However, long-term outcomes for Japanese patients remain unknown. In this study, we aimed to investigate the performance of AorfixTM in Japanese patients with highly angulated aortic necks. Methods: Among 114 patients in whom AorfixTM was used for EVAR at a single institution from October 2014 to October 2021, 105 patients without rupture or infection were retrospectively reviewed. They were classified into the following two groups: those with proximal neck angulations of ≥60° and <60°. Endpoints included technical success, long-term survival, freedom from aneurysm-related mortality, and freedom from reintervention. Results: Among 105 cases reviewed, 54 and 51 had proximal neck angulations of <60° and ≥60°, respectively. The <60° and ≥60° groups had a mean neck angulation of 30.7° (median 30°, range 10-56°) and 80.3° (median 77°, range 60-110°), respectively. The ≥60° group had significantly increased operation time (p = 0.034), volume of contrast agent used during the operation (p = 0.0301), and duration of fluoroscopy during the operation (p < 0.0001); however, the rates of additional renal artery stenting, cuff placement, and access site complications did not differ between the groups. There were also no differences in the incidence of aneurysm enlargements, secondary intervention, and endoleaks incidence. Conclusions: EVAR with AorfixTM achieved satisfactory results in Japanese patients with severe and mild/moderate proximal neck angulation.