Complications and Reinterventions After Fenestrated and Branched EVAR in Patients with Paravisceral and Thoracoabdominal Aneurysms

Huang, Ivan Kuang Hsin; Renani, Seyed Ameli; Morgan, Robert

doi:10.1007/s00270-018-1917-0

Cited by 11 publications

(10 citation statements)

References 64 publications

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“…One of the key improvements was the introduction of BSGs leading to higher TV patency rates, 9 which are currently reported as 92% to 99% in mid-to long-term follow-up. [10][11][12][13] However, most of the reinterventions following fEVAR are still for TV-associated complications 4,5 and may be related to anatomical changes induced by the operation. 6,7 Indeed, significant anatomical changes of the renovisceral arteries can be observed immediately after fEVAR.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the reinterventions are required for TV problems such as type III endoleaks, stenosis, and occlusion. 4,5 Geometrical changes in the TV after f/bEVAR have been reported, [6][7][8] and it has been hypothesized that those anatomical changes may predispose to TV-related complications. 6,7 In a previous study assessing the immediate changes of the TV anatomy after fEVAR using 3 different types of BSGs and 2 types of main devices, 7 no significant differences among the different materials were found.…”

Section: Introductionmentioning

confidence: 99%

“…Most of the reinterventions are required for TV problems such as type III endoleaks, stenosis, and occlusion. 4,5…”

Section: Introductionmentioning

confidence: 99%

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Changes in Target Vessel Anatomy Following Fenestrated Endovascular Aneurysm Repair: Midterm Results

et al. 2020

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Purpose: To analyze the changes in target vessel (TV) anatomy after fenestrated endovascular aneurysm repair (fEVAR) during midterm follow-up. Materials and Methods: A retrospective single-center study analyzed 56 patients (mean age 71±7 years; 49 men) who underwent fEVAR using custom-made stent-grafts (22 Zenith and 34 Anaconda) between June 2010 and July 2016. Advanta V12 (V12; 74, 53%) and BeGraft (BeG; 66, 47%) stent-grafts were used to bridge to the 140 TVs. Measurements of the TV deviation at the aortic origin, the vessel shift distal to the bridging stent-graft (BSG), and the outer and inner BSG curve lengths were performed after 3-dimensional reconstruction of the serial computed tomography angiography scans. The results of the measurements for the main devices, the TVs, and the bridging stent-grafts were compared using univariable and multivariable analysis. Results: Of the 140 BSGs examined (74 V12s and 66 BeGs), 393 measurements (38 celiac trunks, 102 superior mesenteric arteries, 121 left renal arteries, and 132 right renal arteries) were analyzed. The outer/inner BSG curve length ratio was larger after implantation of Zenith devices compared with Anaconda (p<0.001). The vessel shift distal to the BSG was significantly associated with the interaction of the TV and type of BSG only in the univariable analysis (p=0.001). There were no significant changes of the TV deviation at the aortic origin. Only the outer BSG curve length was significantly associated with TV complications (p=0.033). Median follow-up was 24 months (range 2–61). The BSG curve length ratio showed a significant increase over time (p<0.001) but did not differ between the BeG and V12 (p=0.381). Conclusion: No difference was found between the V12 and the BeG stent-grafts regarding anatomical TV changes during midterm follow-up after fEVAR. Both stent-grafts adapt to the TV anatomy over time, and moderate anatomical changes seem to be tolerated without increasing the risk for TV complications. The type of main device also influences the TV anatomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in Target Vessel Anatomy Following Fenestrated Endovascular Aneurysm Repair: Midterm Results

et al. 2020

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“…Furthermore, longer procedure times involved in complex EVAR expose the patient to longer anesthesia, resulting in a prolonged recovery. 5 Superior clinical outcomes with image fusion have been described in complex EVAR. 4,[6][7][8][9][10] However, there is no general agreement about the need for image fusion in standard EVAR.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, longer procedure times involved in complex EVAR expose the patient to longer anesthesia, resulting in a prolonged recovery. 5…”

Section: Introductionmentioning

confidence: 99%

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

et al. 2020

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Purpose: To determine if image fusion will reduce contrast volume, radiation dose, and fluoroscopy and procedure times in standard and complex (fenestrated/branched) endovascular aneurysm repair (EVAR). Materials and Methods: A search of the PubMed, Embase, and Cochrane databases was performed in December 2019 to identify articles describing results of standard and complex EVAR procedures using image fusion compared with a control group. Study selection, data extraction, and assessment of the methodological quality of the included publications were performed by 2 reviewers working independently. Primary outcomes of the pooled analysis were contrast volume, fluoroscopy time, radiation dose, and procedure time. Eleven articles were identified comprising 1547 patients. Data on 140 patients satisfying the study inclusion criteria were added from the authors’ center. Mean differences (MDs) are presented with the 95% confidence interval (CI). Results: For standard EVAR, contrast volume and procedure time showed a significant reduction with an MD of −29 mL (95% CI −40.5 to −18.5, p<0.001) and −11 minutes (95% CI −21.0 to −1.8, p<0.01), respectively. For complex EVAR, significant reductions in favor of image fusion were found for contrast volume (MD −79 mL, 95% CI −105.7 to −52.4, p<0.001), fluoroscopy time (MD −14 minutes, 95% CI −24.2 to −3.5, p<0.001), and procedure time (MD −52 minutes, 95% CI −75.7 to −27.9, p<0.001). Conclusion: The results of this meta-analysis confirm that image fusion significantly reduces contrast volume, fluoroscopy time, and procedure time in complex EVAR but only contrast volume and procedure time for standard EVAR. Though a reduction was suggested, the radiation dose was not significantly affected by the use of fusion imaging in either standard or complex EVAR.

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Fenestrated/branched endovascular aortic repair using unilateral femoral access in patients with iliac occlusive disease

Rogers

Lemmens

Tenorio

et al. 2023

Journal of Vascular Surgery

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Complications and Reinterventions After Fenestrated and Branched EVAR in Patients with Paravisceral and Thoracoabdominal Aneurysms

Cited by 11 publications

References 64 publications

Changes in Target Vessel Anatomy Following Fenestrated Endovascular Aneurysm Repair: Midterm Results

Changes in Target Vessel Anatomy Following Fenestrated Endovascular Aneurysm Repair: Midterm Results

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Fenestrated/branched endovascular aortic repair using unilateral femoral access in patients with iliac occlusive disease

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