Perioperative Outcome of Fenestrated and Branched Stent Grafting after Previous Open or Endovascular Abdominal Aortic Repair

Makaloski, Vladimir; Tsilimparis, Nikolaos; Panuccio, Giuseppe; Σπανός, Κωνσταντίνος; Wyss, Thomas R.; Rohlffs, Fiona; Debus, Eike Sebastian; Kölbel, Tilo

doi:10.1016/j.avsg.2020.12.047

Cited by 9 publications

(7 citation statements)

References 27 publications

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“…Treatment of a previously failed infrarenal AAA repair is a complex undertaking, and this analysis of F-BEVAR for a failed pEVAR or pOAR confirms its feasibility and safety in terms of technical success and 30-day mortality, as well as satisfactory mid-term effectiveness as demonstrated in previous studies 6,9,14–16 . However, only few studies have analyzed the comparative outcomes of F-BEVAR after either previous open or endovascular repair, a novel aspect of this report 17 . In that sense, the presented cohort is the largest of its kind to date, and the inclusion of an almost equal number of pEVAR and pOAR patients offers important insights in future treatment considerations.…”

Section: Discussionsupporting

confidence: 76%

“…6,9,[14][15][16] However, only few studies have analyzed the comparative outcomes of F-BEVAR after either previous open or endovascular repair, a novel aspect of this report. 17 In that sense, the presented cohort is the largest of its kind to date, and the inclusion of an almost equal number of pEVAR and pOAR patients offers important insights in future treatment considerations. Indeed, the pooled rate of perioperative morbidity is comparatively low in light of some of the contemporary series of surgical conversion after EVAR, [18][19][20] as well as recent series of complex endovascular repair for native aortic aneurysms.…”

Section: Discussionmentioning

confidence: 97%

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European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair

et al. 2022

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Objective: To report the mid-term outcomes of fenestrated-branched endovascular aneurysm repair (F-BEVAR) following a failed previous endovascular aneurysm repair (pEVAR) or previous open aneurysm repair (pOAR). Methods: Data from consecutive patients who underwent F-BEVAR for pEVAR or pOAR from 2006 to 2021 from 17 European vascular centers were analyzed. Endpoints included technical success, major adverse events, 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth >5 mm. Background: Treatment of a failed previous abdominal aortic aneurysm repair is a complex undertaking. F-BEVAR is becoming an increasingly attractive option, although comparative data are limited regarding associated risk factors, indications for treatment, and various outcomes. Results: There were 526 patients included, 268 pOAR and 258 pEVAR. The median time from previous repair to F-BEVAR was 7 (interquartile range, 4–12) years, 5 (3–8) for pEVAR, and 10 (6–14) for pOAR, P<0.001. Predominant indication for treatment was type Ia endoleak for pEVAR and progression of the disease for pOAR. Technical success was 92.8%, pOAR (92.2%), and pEVAR (93.4%), P=0.58. The 30-day mortality was 6.5% overall, 6.7% for pOAR, and 6.2% for pEVAR, P=0.81. There were 1853 treated target vessels with 5-year estimates of primary patency of 94.4%, pEVAR (95.2%), and pOAR (94.4%), P=0.03. Five-year estimates for freedom from type I/III endoleaks were similar between groups; freedom from reintervention was lower for pEVAR (38.3%) than for pOAR (56.0%), P=0.004. The most common indication for reinterventions was for type I/III endoleaks (37.5%). Conclusions: Repair of a failed pEVAR or pOARis safe and feasible with comparable technical success and survival rates. While successful treatment can be achieved, significant rates of reintervention should be anticipated, particularly for issues related to instability of target vessels/bridging stents.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 97%

European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair

et al. 2022

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“…During the past decade, the endovascular treatment of complex aortic aneurysms with fenestrated and branched stent grafts became a popular option due to its low perioperative mortality and morbidity [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 15 , 16 ]. Custom-made devices (CMD), designed upon each patient’s specific anatomy, offer a dedicated treatment solution and allow an individual position of fenestrations and directional branches depending on the patient’s anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…The endovascular treatment of complex aortic aneurysms (thoracoabdominal, pararenal, and juxtarenal) has been widely accepted as a safe and effective technique [ 1 , 2 , 3 , 4 , 5 ]. Fenestrated and branched endovascular aneurysm repair (F/B-EVAR) has demonstrated high rates of technical and clinical success and low early post-operative mortality [ 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Directional Branches of the T-Branch Off-the-Shelf Multi-Branched Stent-Graft

Σπανός

Jakimowicz

Nana

et al. 2022

JCM

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Background: A controversy on bridging covered stent (BCS) choice, between self-expanding (SECS) and balloon-expandable (BECS) stents, still exists in branched endovascular repair. This study aimed to determine the primary target vessel (TV) patency in patients treated with the t-Branch device and identify factors impairing the outcomes. Methods: A retrospective study was undertaken, including patients treated with the t-Branch (Cook Medical, Bloomington, IN, USA) between 2014 and 2019 (early 2014–2016; late 2017–2019). The endpoint was the primary patency (CT: celiac trunk, SMA, superior mesenteric artery, RRA: right renal artery, LRA: left renal artery) during the follow-up. Any branch instability event was assessed. The factors affecting the patency were determined using multivariable regression models and Kaplan–Meier analyses. Results: In total, 2018 TVs were analyzed; 1542 SECSs and 476 BECSs. The CT patency was 99.8% (SE 0.2%) at the 1st month, with no other event. The SMA patency was 97.8% (SE 1) at the 12th month. The RRA patency was 96.7% (SE 2) at the 24th month. The LRA patency was 99% (SE 0.4) at the 6th month. Relining was the only factor independently associated with the SMA patency (OR 8.27; 95% CI 1.4–4.9; p = 0.02). The freedom from instability was 62% (SE 4.3%) and 45% (SE 5.4%) at the 24th month and 36th month. No significant difference was identified between the BECSs and SECSs in the early or late experience. Conclusion: BCS for the t-Branch branches performed with a good primary patency during the short-term follow-up. The type of BCS did not influence the patency. Relining might be protective for SMA patency.

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“…Technical developments of endovascular aortic repair (EVAR) and visceral stenting nowadays allow the safe and durable treatment of the visceral aortic segment. Since the first implantation of a fenestrated stent graft in 1998 by Anderson, significant advantages of fenestrated/branched endovascular aortic repair (FBEVAR) have been shown regarding mortality and morbidity compared to open surgical repair [ 1 , 2 , 3 ]. FBEVAR has been widely adopted in several countries during the last decade, which provided scientific evidence to support the recent guideline recommendations of the European Society for Vascular Surgery favouring FBEVAR over open surgery for patients with a suitable anatomy [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Complex Aortic Interventions Can Be Safely Introduced to the Clinical Practice by Physicians Skilled in Basic Endovascular Techniques

Borzsák

Szentiványi

Süvegh

et al. 2022

Life

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Our purpose was to evaluate the risk associated with the learning curve of starting a complex aortic programme in an Eastern European country. A retrospective study was conducted involving the initial 20 patients (16 males, mean age: 65 ± 11 years) undergoing fenestrated/branched endovascular aortic repair in a single centre. Demographic, anatomical, procedural, and postoperative variables were collected. Our elective patient cohort consisted of 9 pararenal aneurysms (45%) and 11 thoracoabdominal aortic aneurysms (55%), with the latter including 4 chronic dissection cases (20%). A total of 71 branch vessels were incorporated (3.5 ± 0.9 per patient). The per vessel technical success rate was 100%. In-hospital mortality was 5% (1/20). At an average follow-up of 14 ± 22 months, the primary clinical success rate was 45% (9/20) and the secondary clinical success was achieved in 75% of cases (15/20). All-cause mortality at 14 months was 20% (4/20; aortic related: 1/20, 5%). Four bridging stent occlusions were found (5.6%). Mortality and reintervention rates were comparable to the initial results of high-volume centres, while the complexity of our cases and the per vessel technical success rate was comparable to the values reported as late experience. The morbidity of the learning curve could be decreased if operators are skilled in basic endovascular procedures.

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Perioperative Outcome of Fenestrated and Branched Stent Grafting after Previous Open or Endovascular Abdominal Aortic Repair

Cited by 9 publications

References 27 publications

European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair

European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair

Outcomes of Directional Branches of the T-Branch Off-the-Shelf Multi-Branched Stent-Graft

Complex Aortic Interventions Can Be Safely Introduced to the Clinical Practice by Physicians Skilled in Basic Endovascular Techniques

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