RESUMO
OBJECTIVES: Endovascular aneurysm repair (EVAR) in a hostile neck has been associated with adverse outcomes. We aimed to determine the association of infrarenal aortic neck angle and length and establish an optimal cutoff value to predict intraoperative neck complications and postoperative outcomes. METHODS: This was a retrospective review of patients with an intact infrarenal abdominal aortic aneurysm (AAA) with severe neck angulation (>60 degrees) who underwent EVAR from October 2010 to October 2018. Demographic data, aneurysm morphology, and operative details were collected. The ratio of neck angle and length was calculated as the optimal cutoff value of the aortic neck angle-length index. The patients were categorized into two distinct groups using latent profile analysis, a statistical technique employed to identify concealed subgroups within a larger population by examining a predetermined set of variables. Intraoperative neck complications, adjunct neck procedures, and early and late outcomes were compared. RESULTS: 115 patients were included. Group 1 (G1) had 95 patients with an aortic neck angle-length index ≤ 4.8, and Group 2 (G2) had 20 patients with an aortic neck angle-length index > 4.8. Demographic data and aneurysm morphology were not significantly different between groups except for neck length (p < 0.001). G2 had more intraoperative neck complications than G1 (21.1% vs. 55%, p = 0.005). Adjunctive neck procedures were more common in G2 (18.9% vs. 60%, p < 0.001). The thirty-day mortality rate was not statistically different. G1 patients had a 5-year proximal neck re-intervention-free rate comparable to G2 patients (93.7% G1 vs. 87.5% G2, p = 0.785). The 5-year overall survival rate was not statistically different (59.9% G1 vs. 69.2% G2, p = 0.891). CONCLUSIONS: Patients with an aortic neck angle-length index > 4.8 are at greater risk of intraoperative neck complications and adjunctive neck procedures than patients with an aortic neck angle-length index ≤ 4.8. The 5-year proximal neck re-intervention-free rate and the 5-year survival rate were not statistically different. Based on our findings, this study suggests that the aortic neck angle-length index is a reliable predictor of intraoperative neck complications during EVAR in AAA with severe neck angulation.
RESUMO
OBJECTIVE: To report an experience with Meckel's diverticulum (MD) from a University Hospital in Thailand, and to compare the characteristics of MD removal from asymptomatic patients and symptomatic patients. MATERIAL AND METHOD: The authors retrospectively reviewed the medical records of patients undergoing the resection of MD between January 1994 and July 2011 at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok. The patients were subsequently divided into two groups. The asymptomatic group included individuals with MD that were found incidentally during the course of laparotomy performed for reasons not related to the complications of the MD. The symptomatic group included individuals presenting with complications related to the MD. Data were recorded including patient's demographics, clinical presentation, histopathologic findings, and postoperative outcomes. RESULTS: The present study included 84 patients (53 males, 63%). Of whom, 60 patients (71%) were pediatric (age < 16 years) and 51 patients (61%) were symptomatic. The most common presentation of symptomatic MDs in pediatric and adult patients was lower gastrointestinal bleeding and mechanical small bowel obstruction, respectively. The correct preoperative diagnosis of MD was made in only 20 patients (39%) of the symptomatic group, all with 99mTc-pertechnetate scanning. The MDs in the symptomatic group were significantly longer with a wider base than those in the asymptomatic group, 3.2 vs. 2.0 cm in length (p = 0.001) and 1.8 vs. 1.0 cm in width (p < 0.001). Ectopic tissue was present more significant in the symptomatic group than in the asymptomatic group (51% vs. 12%; p < 0.001). None of the resected MDs contained neoplasm. There was no significant difference in the morbidity or mortality rate between the symptomatic and asymptomatic groups. CONCLUSION: The MDs in the symptomatic patients were significantly longer with a wider base than those in the asymptomatic patients. Symptomatic MDs contained ectopic tissue more frequently than asymptomatic MDs.
