Endovascular repair of thoraco-abdominal aortic aneurysms by fenestrated and branched endografts†

Abstract

OBJECTIVES Our objective was to report the outcomes of fenestrated/branched endovascular aneurysm repair of thoraco-abdominal aortic aneurysms (TAAAs) with endografts. METHODS Between January 2010 and April 2018, patients with TAAAs, considered at high surgical risk for open surgery and treated by Cook-Zenith fenestrated/branched endovascular aneurysm repair, were prospectively enrolled and retrospectively analysed. The early end points were 30-day/hospital mortality rate, spinal cord ischaemia and 30-day cardiopulmonary and nephrological morbidity. Follow-up end points were survival, patency of target visceral vessels and freedom from reinterventions. RESULTS Eighty-eight patients (male: 77%; mean age: 73 ± 7 years; American Society of Anesthesiologists 3/4: 58/42%) were enrolled. Using Crawford’s classification, 43 (49%) were types I–III and 45 (51%) were type IV TAAAs. The mean aneurysm diameter was 65 ± 15 mm. Custom-made and off-the-shelf endografts were used in 60 (68%) and 28 (32%) cases, respectively. Five (6%) patients had a contained ruptured TAAA. The procedure was performed in multiple steps in 42 (48%) cases. There was 1 (1%) intraoperative death. Five (6%) patients suffered spinal cord ischaemia with permanent paraplegia in 3 (3%) cases. Postoperative cardiac and pulmonary complications occurred in 7 (8%) and 12 (14%) patients, respectively. Worsening of renal function (≥30% of baseline level) was detected in 11 (13%) cases, and 2 (2%) patients required haemodialysis. The 30-day and hospital mortality rates were 5% and 8%, respectively. The mean follow-up was 36 ± 22 months. Survival at 12, 24 and 36 months was 89%, 75% and 70%, respectively. The patency of target visceral vessels at 12, 24 and 36 months was 92%, 92% and 92%, respectively. Freedom from reinterventions at 12, 24 and 36 months was 85%, 85% and 83%, respectively. CONCLUSIONS The endovascular repair of TAAAs with fenestrated/branched endovascular aneurysm repair is feasible and effective with acceptable technical/clinical outcomes at early/midterm follow-up.

Custom-made fenestrated stent for mycotic aortic aneurysms: a report of two cases

“…Survival at 1 year was 86 % and at 2 years was 68 %. The patency of target visceral vessels at 2 years was 92% [ 9 ]. A recent publication from Niet et al reported favorable results in 335 patients with complex AAA which included short neck, juxtarenal and thoracoabdominal aortic aneurysm.…”

Intracranial Hemorrhage After Endovascular Repair of Thoracoabdominal Aortic Aneurysm

“…A number of clinical characteristics and perioperative technical aspects were recorded, as previously described. 7,8 Patient’s clinical characteristics considered were: sex, hypertension (presence of systolic blood pressure >140 mm Hg or/and diastolic >90 mm Hg or specific therapy), dyslipidemia (total cholesterol >200 mg/dL or low-density lipoprotein >120 mg/dL or specific therapy), diabetes mellitus (under treatment with oral hypoglycemic drugs or with insulin), coronary artery disease (defined as a history of angina pectoris, myocardial infarction, or coronary revascularization), chronic obstructive pulmonary disease (defined as chronic bronchitis or emphysema), and chronic kidney disease (CKD) (estimated glomerular filtration rate <60 mL/min), 9 peripheral artery obstructive disease (PAOD, previous peripheral artery revascularization, presence of lower limb claudication with ascertained arterial disease at duplex evaluation or rest pain or ischemic ulcer), American Society of Anesthesiologists (ASA) score as evaluated by a dedicated anesthesiologist. Oral anticoagulant therapy was considered.…”

“…TAAA endovascular treatment was performed as previously reported. 7,8 The F/BEVAR implant was planned by the same surgical team who performed the procedure; for custom made devices, planning was confirmed by the Cook Zenith Planning Centre for fenestrated and branched endograft. Renal artery revascularization was performed by fenestration or branch design according to aortic lumen diameter at the level of the renal artery origins.…”

Fenestrated and Branched Stent-Grafts for the Treatment of Thoracoabdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis

“…Since 2001, Chuter et al ( 6 ) has successfully accomplished total endovascular repair of a TAAA with branched stent-grafts, and total endovascular repair with fenestrated and branched stent-grafts has constantly evolved and become a minimally invasive alternative option for the treatment of TAAAs, especially for patients who may not tolerate open surgery. Although increasing reports on this endovascular technique have indicated encouraging outcomes ( 7 – 9 ), there have been few meta-analyses regarding total endovascular TAAA repair using fenestrated and branched stent-grafts to date.…”