Secondary interventions after fenestrated and branched endovascular repair of complex aortic aneurysms

Silverberg, Daniel; Aburamileh, Ahmad; Rimon, Uri; Raskin, Daniel; Khaitovich, Boris; Halak, Moshe

doi:10.1016/j.jvs.2019.10.068

Cited by 23 publications

(18 citation statements)

References 11 publications

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“…This attachment can be prone to failure due to stent fracture or migration, resulting in endoleaks or stenosis and occlusion of the branch. 13 Directional OBs offer the advantage of providing an overlap between the aortic and the bridging module, thus allowing for a certain degree of freedom in movement without creating an endoleak due to separation of the components. They are typically manufactured pointing caudally, which is useful when the target vessel is downward pointing, anatomy frequently encountered in the CA and the SMA.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of inner branches for endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms

et al. 2020

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Objectives To report our early experience using endografts with inner branches for the treatment of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs). Methods A retrospective analysis of all patients treated in our institution for complex abdominal aortic aneurysms and TAAAs with custom-made stent grafts consisting of one or more inner branches. Data collected included patients demographics, aortic aneurysm morphology, stent grafts features, perioperative morbidity and mortality and short-term reintervention and mortality rates. Results Twenty-seven patients (18 males, mean age 70 ± 7.1) were included. Indications for surgery included TAAAs (12, 41%) juxtarenal abdominal aortic aneurysms (10, 37%), type 1A endoleaks (4, 15%) and paraanastamotic aneurysms (1, 4%). A total of 90 inner branches were used. Twenty-one (78%) of the stent grafts consisted only of inner branches and six (22%) had a combination of inner branches with either fenestrations or outer branches. Technical success was achieved in 26/27 (96%) of the patients. There was one perioperative mortality. Six patients suffered from major perioperative adverse events. Mean follow-up was seven months (range 1–23). During the follow-up period, four patients (15%) required reinterventions. Branch-related reinterventions were performed in two (7%) patients. No occlusions of inner branches occurred during the follow-up. Conclusions Inner branches in branched endovascular aneurysm repairs offer a feasible option for the treatment of complex abdominal aortic aneurysms and TAAAs. The procedures can be completed with high technical success and with acceptable short-term branch-related reintervention rates. Further follow-up is required to determine the long-term durability of this technology.

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Section: Discussionmentioning

confidence: 99%

Short-term outcomes of inner branches for endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms

et al. 2020

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“…With a technical success rate of 97% in post-dissection aneurysms, our cohort compares well with previous studies and, similar to Tenorio [ 8 ], did not report any significant difference between the two groups. Despite satisfactory technical success rates, unplanned reinterventions continue to be a major issue in FBEVAR and more importantly, in post-dissection aneurysms [ 11 , 12 , 13 , 14 ]. Oikonomou reported a cumulative reintervention rate of 20% at 1 year, the majority of which were due to target vessel instability and endoleak [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is well established that the higher the number of stent–graft components, the greater the potential for failure of attachment sites leading to endoleaks and the need for reinterventions [ 18 ]. Other major causes of unplanned reinterventions in FBEVAR are graft-limb occlusions and target vessel instability [ 11 , 12 , 19 , 20 , 21 ]. This was corroborated by our study, with graft limb occlusions occurring in 5% of the cohort, while target vessel relining and recanalization procedures were performed in 11/27 reinterventions.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes and Reinterventions Following Fenestrated/Branched Endovascular Aortic Repair in Post-Dissection and Complex Degenerative Abdominal and Thoraco-Abdominal Aortic Aneurysms

Benfor

Högl

Melo

et al. 2022

JCM

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Background: The outcome of FBEVAR in post-dissection thoracoabdominal aortic aneurysms has not been well established in the literature. The aim of this study was to compare midterm outcomes following FBEVAR in post-dissection aneurysms to degenerative aneurysms. (2) Methods: This was a retrospective review of all patients undergoing FBEVAR in a single center between 2017 and 2020. The baseline characteristics, intraoperative details, and postoperative outcomes of patients with post-dissection aneurysms were compared to those with degenerative outcomes. The primary end point was unplanned reinterventions. Cox regression analysis was performed to identify the determinants of worse outcomes. Results: A total of 137 subjects with a mean age of 70 ± 10 years were included in the study, out of which 30 presented post-dissection aneurysms (22%). Custom-made devices were employed in 119 patients, off-the-shelf devices in 13 and physician-modified endografts in 5, with incorporation in 505 target vessels. The technical success rate was comparable in both groups (97% vs. 98%, p = 0.21). However, the one-year freedom from unplanned reintervention was lower in the post-dissection group (67% vs. 89%, p = 0.011). Conclusion: FBEVAR in post-dissection aneurysms is associated with a favorable technical success rate, but reintervention rates remain high. Long procedural duration and the use of adjunctive techniques are associated with increased risk of reinterventions.

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“…[1][2][3][4][5][6][7][8][9][10] In contrast to standard endovascular aneurysm repair, the increased complexity of F/B-EVAR could lead to different types of complications, such as occlusion of the target visceral vessels (TVVs) and endoleaks from the bridging stents, with the subsequent necessity of reintervention. [11][12][13] The estimated freedom from reinterventions at 3 years after F/B-EVAR has varied and can be as high as 90% in recent series. [1][2][3][4][5][6][7][8][9][10] However, their follow-up results have been largely unknown, especially the occurrence rates and subsequent effects on the overall outcomes.…”

mentioning

confidence: 99%

Reinterventions after fenestrated and branched endografting for degenerative aortic aneurysms

Gallitto

Faggioli

Pini

et al. 2021

Journal of Vascular Surgery

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Secondary interventions after fenestrated and branched endovascular repair of complex aortic aneurysms

Cited by 23 publications

References 11 publications

Short-term outcomes of inner branches for endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms

Short-term outcomes of inner branches for endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms

Postoperative Outcomes and Reinterventions Following Fenestrated/Branched Endovascular Aortic Repair in Post-Dissection and Complex Degenerative Abdominal and Thoraco-Abdominal Aortic Aneurysms

Reinterventions after fenestrated and branched endografting for degenerative aortic aneurysms

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