Endovascular Repair of Thoracoabdominal and Arch Aneurysms in Patients with Connective Tissue Disease Using Branched and Fenestrated Devices

Clough, Rachel E.; Martin-Gonzalez, Térésa; Calster, Katrien Van; Hertault, Adrien; Spear, Rafaëlle; Azzaoui, Richard; Sobocinski, Jonathan; Haulon, Stéphan

doi:10.1016/j.avsg.2017.05.013

Cited by 35 publications

(16 citation statements)

References 27 publications

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“…Despite general recommendations against endovascular repair in patients with genetic aortic syndromes (GAS) recent publications have reported mortality, stroke, and SCI rates comparable to those observed in patients without GAS. 13,14 In the presented case the patient was deemed to be a poor candidate for open repair with a high risk for perioperative complications based on limited cardiac function. Endovascular therapy was decided as the best treatment modality.…”

Section: Discussionmentioning

confidence: 98%

Complex Endovascular Aortic Repair With a Branched Endograft to Revascularize 5 Renovisceral Vessels and an Intercostal Artery in a Marfan Patient

et al. 2019

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Purpose: To report a case of thoracoabdominal aortic aneurysm (TAAA) repair treated with a multibranched stent-graft including a prophylactic branch for a large intercostal artery in a Marfan patient at risk for spinal cord ischemia (SCI). Case Report: A 43-year-old man with Marfan syndrome presented with a type IV thoracoabdominal aortic aneurysm (TAAA) and history of multiple previous cardiac and aortic operations over the past 28 years. The maximum diameter of the aneurysm was 60 mm. The patient had 2 right renal arteries and 2 reimplanted segmental arteries (1 occluded). With the goal of preserving both right renal arteries and the large intercostal artery, a 6-branch, custom-made stent-graft was planned and manufactured. Bilateral femoral and right brachial artery access was used. The intercostal artery was catheterized and connected to the retrograde branch from a femoral access. Final angiography and predischarge computed tomography angiography (CTA) showed unimpeded flow to all 6 target vessels. The patient was discharged on postoperative day 10 without clinical signs of SCI. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 6 branches. Conclusion: Multibranched endovascular aortic repair with a branch to a large intercostal artery was technically feasible and clinically successful.

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Section: Discussionmentioning

confidence: 98%

Complex Endovascular Aortic Repair With a Branched Endograft to Revascularize 5 Renovisceral Vessels and an Intercostal Artery in a Marfan Patient

et al. 2019

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“…However, in this study, the patency of bridging covered stents and visceral vessel bypasses in F/B-EVAR and hybrid procedures were comparable to the literature of patients with nonconnective tissue disorders. 23,24,26 An evolving solution for the visceral aortic segment in patients with MFS could be the introduction of a hybrid thoracoabdominal graft. 29 Freedom from re-intervention was acceptable in the current study with 77% at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Aortic Pathologies in Patients With Marfan Syndrome: Single-Center Experience

Kölbel¹,

Eleshra²,

Aldağ³

et al. 2021

J Endovasc Ther

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Objectives: To study the outcome of endovascular treatment of aortic pathologies in patients with Marfan syndrome (MFS) at a single institution. Methods: Consecutive MFS patients who underwent endovascular repair or hybrid procedures for aortic pathologies from January 2010 to May 2020 were identified. Several endovascular and hybrid strategies have been used. Technical success, short- and mid-term survival, complications, and re-interventions were retrospectively analyzed. Results: During the study period, 24 patients with MFS (median age, 48 [13–78] years; 58% males) were treated. Indications for intervention were chronic aortic dissection with aneurysm degeneration in 16 patients (67%), acute type B aortic dissection in 4 patients (17%), aortic aneurysm without any dissection in 3 patients (13%), and aortic intramural hematoma in 1 patient (4%). Most patients were asymptomatic (83%), three (13%) were symptomatic and one (4%) had a contained rupture. The median aneurysm diameter was 56 (35–86) mm. Hybrid procedures were performed in 7 (29%) patients. Thoracic endovascular repair was performed in 12 (50%) patients, a fenestrated or branched endovascular aortic repair in 4 (17%) patients, and placement of an iliac artery stent-graft in 1 (4%) patient. Procedures were staged in 12 (50%) patients. Technical success was achieved in all patients. The median intensive care unit stay was 6 (range, 1–30) days, and the median hospital stay was 23 (range, 3–112) days. Early mortality was reported in 1 (4%) patient. Wound infection was seen in 7 (29%) patients and gastrointestinal complications in 3 (13%) patients. The median follow-up was 42 (range, 1–127) months. The cumulative survival rate was 87% at 24 months. The cumulative freedom from re-intervention was 77% at 12 months. Conclusions: Endovascular treatment of aortic pathologies in patients with MFS appears feasible with acceptable early and mid-term outcomes in terms of mortality and re-intervention rates. Endovascular therapy plays an increasing role in MFS patients with aortic pathology.

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“…Furthermore, the Lille team published the first study of fenestrated or branched stent grafts to treat the thoracoabdominal aorta in chronic aortic dissection associated with connective tissue disorders. 9 They reported 17 patients unfit for surgery, including four with MFS and known FBN1 gene mutation. The early outcomes were favourable with no spinal cord ischaemia or deaths.…”

Section: Staged Strategy and Extensive Aortic Repair In Mfsmentioning

confidence: 99%

Optimising Aortic Endovascular Repair in Patients with Marfan Syndrome

Pellenc

Girault

Roussel

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThe described protocol of endovascular aortic repair in patients with Marfan syndrome seems promising because it leads to significant aortic remodelling while the rate of landing zone complication remains low. The article emphasizes the benefit of integrating endovascular aortic repair in a multistage aortic repair strategy, which may lead to total aortic replacement eventually.Objective: In Marfan syndrome (MFS) patients, endovascular repair carries a risk of aortic wall injury, which may result in retrograde aortic dissection, dilatation, or false aneurysm at the landing zones. It was hypothesised that potentially these complications may be avoided using modified practices. This study aimed to describe experience of a specific protocol for endovascular aortic repair in patients with MFS. Methods: All MFS patients treated by aortic endovascular repair between February 2015 and August 2018 were included prospectively. The following rules were applied: (i) excluding stent grafts with bare stents and barbs, (ii) proximal landing in a pre-existing graft, or (iii) minimising proximal oversizing when landing in the proximal native aorta (<10%), and (iv) distal undersizing for chronic dissection cases. Results: In eighteen patients (55% men, mean age: 47 AE 17 years), the index procedures were initial endovascular aortic repair (n ¼ 10), elephant trunk completion (n ¼ 6), and anastomotic pseudo-aneurysm after thoracic open repair (n ¼ 2). The technical success rate was 100%. Proximal landing was in the native aorta in 11 patients (61%), with a mean proximal oversizing of 2.4 mm (8% oversized). Distal landing in the native aorta was performed in 16 cases (89%), with a mean distal undersizing of 8.9 mm (e 23%). No mortality, spinal cord ischaemia, stroke, or retrograde aortic dissection occurred post-operatively. One type 1b endoleak was observed. The mean follow up was 21.4 months. Aortic aneurysm related mortality was 5% (n ¼ 1) and occurred after distal thoraco-abdominal surgery planned from the outset (prior to endovascular repair). Another patient presented a proximal landing zone complication with aortic enlargement. The mean maximum aortic diameter decreased significantly from 59 mm to 45 mm (p ¼ .0005) after treatment. Conclusion: The specific protocol described in this study seems to optimise the results of endovascular aortic repair in MFS patients with significant aortic remodelling.

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Endovascular Repair of Thoracoabdominal and Arch Aneurysms in Patients with Connective Tissue Disease Using Branched and Fenestrated Devices

Cited by 35 publications

References 27 publications

Complex Endovascular Aortic Repair With a Branched Endograft to Revascularize 5 Renovisceral Vessels and an Intercostal Artery in a Marfan Patient

Complex Endovascular Aortic Repair With a Branched Endograft to Revascularize 5 Renovisceral Vessels and an Intercostal Artery in a Marfan Patient

Endovascular Treatment of Aortic Pathologies in Patients With Marfan Syndrome: Single-Center Experience

Optimising Aortic Endovascular Repair in Patients with Marfan Syndrome

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