Adapting to a total endovascular approach for complex aortic aneurysm repair: Outcomes after fenestrated and branched endovascular aortic repair

Budtz-Lilly, Jacob; Wanhainen, Anders; Eriksson, J.; Mani, Kevin

doi:10.1016/j.jvs.2017.03.422

Cited by 50 publications

(26 citation statements)

References 32 publications

(44 reference statements)

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“…In all, 15.0% (juxtarenal AAA) and 22.6% (TAAA) of patients had chronic kidney failure prior to intervention. Permanent post-procedural spinal damage was observed in only 2.8% of patients [9]. …”

Section: Discussionmentioning

confidence: 99%

“…2017 [24]2006–2016 n  = 17 (of 283 evaluated)Single centerElective TEVAR including celiac artery100% technical success, 0% hospital mortality(74 years, 47% males)Budtz-Lilly et al. 2017 [9]2010–2015 n  = 71Single centerJuxtarenal and pararenal AAA, type II–IV TAAA, elective and emergency, f‑EVAR, b‑EVAR95–96% technical success, AAA: 2.5% mortality at 30 daysTAAA: 3.7% mortality at 30 daysAAA: (73 years, 85% males), TAAA: (70 years, 48.4% males)Eagleton et al. 2016 [13] a 2004–2013 n  = 354–Type II and III TAAA, elective f‑EVAR, b‑EVAR94.1% technical success, 4.8% mortality at 30 days(73.5 years, 76.3% males)Martin-Gonzales et al.…”

Section: Discussionmentioning

confidence: 99%

“…2017 [24]–18 (AF)12 (CHD)100531212Budtz-Lilly et al. 2017 [9]12.721.1 (AF)39.483.131.05.618.3Eagleton et al. 2016 [13] a –24.943.8–30.814.718.6Martin-Gonzales et al.…”

Section: Discussionmentioning

confidence: 99%

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Complex endovascular treatment of intact aortic aneurysms

et al. 2018

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BackgroundThe complex endovascular repair of aortic aneurysms and dissections with fenestrated or branched stent grafts (FB-EVAR) remains challenging for interventional vascular surgery. To date, the evidence regarding treatment patterns and outcome measures consists of single center studies; however, it might be reasonable to validate results with multicenter real-world evidence.MethodsHealth insurance claims data from Germany’s third largest insurance provider, DAK-Gesundheit, were used to determine outcomes following FB-EVAR of non-ruptured thoracic aorta (TA) or thoracoabdominal including pararenal abdominal (TAA) aorta. The study included patients operated between January 2008 and April 2017.ResultsIncluded were 984 patients (18.1% female) who underwent FB-EVAR. Patients with treatment of the TA were younger (71.7 vs. 73.2 years, p < 0.001) and more often female (38.5% vs. 17.0%, p < 0.001) as compared to patients with treatment of TAA. In the TA group peripheral arterial disease was less frequent compared to the TAA group (67.3% vs. 80.4%, p = 0.036). Mortality was significantly (p < 0.001) higher following repair of the TAA compared to the TA at discharge (17.3% vs. 4.6%), at 30 days (26.9% vs. 8.2%) and at 90 days (34.6% vs. 10.1%). Patients with treatment of the TAA suffered more often from stroke as compared to the TA group (7.7% vs. 1.2%, p = 0.002).ConclusionIn this large-scale German analysis of claims data, multicenter real-world evidence was different from single center studies regarding patient risk-factors and outcome measures. Validated multicenter registry studies could help to further investigate this topic in times of increasing procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complex endovascular treatment of intact aortic aneurysms

et al. 2018

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“…62 The outcomes of FEVAR and b-EVAR have been reported from various institutions. [62][63][64][65][66][67][68][69][70][71][72] Technical success was achieved in 90 to 97% of elective cases. The 30-day mortality was 0 to 9%, the occurrence rate of SCI was 4 to 12%, and the visceral vessel patency rate was 90 to 100%.…”

Section: Thoracoabdominal Aortic Aneurysmmentioning

confidence: 97%

Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies

2018

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The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.

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“…Over time, however, f/b EVAR has increasingly become the modality of choice for treatment of complex aneurysms at many institutions. 6,7 In contrast to infrarenal AAA repair, the benefit of f/b EVAR over open repair of complex aneurysms has not been established in any randomised trial. While some reports have indicated low peri-operative mortality and morbidity after endovascular repair, these studies are hampered by the risks associated with retrospective analyses, and a mixture of patients with various extents of pathology.…”

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confidence: 99%