The “bare branch” for safe spinal cord ischemia prevention after total endovascular repair of thoracoabdominal aneurysms

Orrico, Matteo; Ronchey, Silvia; Setacci, Carlo; Vona, Alessio; Marino, Mario; Nesi, Fabrizio; Giaquinta, Alessia; Mangialardi, Nicola

doi:10.1016/j.jvs.2018.09.027

Cited by 15 publications

(11 citation statements)

References 22 publications

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“…27 Optimization of collaterals has been targeted using 1 of the 3 techniques: proximal TEVAR, minimally invasive segmental artery coil embolization (MISACE) and TASP. 25,26,28 One of the largest F-BEVAR experiences identified prolonged operative time ( > 300 minutes) as an independent risk factor for SCI, supporting the rationale for short staged procedures. 29 The main limitation to staging remains the interval risk of aneurysm rupture, which ranges from 7.4% to 12.5%.…”

Section: Discussionmentioning

confidence: 90%

“…23 Staging has been advocated by several centers using a variety of techniques that aim to precondition spinal cord perfusion based on the collateral network theory. [24][25][26] Griepp and colleagues demonstrated that spinal cord hypoperfusion leads to morphological changes such as segmental arterial enlargement, redistribution, and reorientation. 27 Optimization of collaterals has been targeted using 1 of the 3 techniques: proximal TEVAR, minimally invasive segmental artery coil embolization (MISACE) and TASP.…”

Section: Discussionmentioning

confidence: 99%

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Prospective Assessment of a Protocol Using Neuromonitoring, Early Limb Reperfusion, and Selective Temporary Aneurysm Sac Perfusion to Prevent Spinal Cord Injury During Fenestrated-branched Endovascular Aortic Repair

et al. 2021

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The aim of this study was to analyze the outcomes of a standardized protocol using routine CSFD, neuromonitoring, LL reperfusion, and selective TASP to prevent SCI during F-BEVAR. Background: SCI is to be the most devastating complication for the patient, family, and surgeon, with impact on patient's quality of life and long-term prognosis. An optimal standardized protocol may be used to improve outcomes. Methods: Patients enrolled in a prospective, nonrandomized single-center study between 2013 and 2018. A SCI prevention protocol was used for TAAAS or complex abdominal aneurysms with ≥5-cm supraceliac coverage including CSFD, neuromonitoring, LL reperfusion, and selective TASP. Endpoints included mortality and rates of SCI. Results: SCI prevention protocol was used in 170 of 232 patients (73%) treated by F-BEVAR. Ninety-one patients (55%) had changes in neuromonitoring, which improved with maneuvers in all except for 9 patients (10%) who had TASP. There was one 30-day or in-hospital mortality (0.4%). Ten patients (4%) developed SCIs including in 1% (1/79) of patients with normal neuromonitoring and 10% (9/91) of those who had decline in neuromonitoring (P = 0.02). Permanent paraplegia occurred in 2 patients (1%). Factors associated with SCI included total operating time (odds ratio 1.5, 95% confidence interval 1.1-2.2, P = 0.02) and persistent changes in neuromonitoring requiring TASP (odds ratio 15.7, 95% confidence interval 2.9-86.2, P = 0.001). Conclusion: This prospective nonrandomized study using a standardized strategy to prevent SCI was associated with low incidence of the SCI during F-BEVAR. Permanent paraplegia occurred in 1%.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Prospective Assessment of a Protocol Using Neuromonitoring, Early Limb Reperfusion, and Selective Temporary Aneurysm Sac Perfusion to Prevent Spinal Cord Injury During Fenestrated-branched Endovascular Aortic Repair

et al. 2021

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“…In this case, the t-Branch was chosen because the anatomy of the three target vessels was favorable. The proximal landing zone, which was in a nonangulated segment of the thoracic aorta, 28 mm in diameter, was suitable for the proper opening of all the branches 14 . One could say that the choice of a t-Branch implied a much greater aortic coverage than a chEVAR procedure would have, but the high risk of gutter-related endoleak in a triple chEVAR procedure was not acceptable in an emergency scenario.…”

Section: Discussionmentioning

confidence: 99%

Late failure of a Nellix endoprosthesis treated with the t-Branch off-the-shelf multibranched stent graft

Lorido

Orrico

Marino

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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A 66-year-old man arrived at our emergency department 3 years after an endovascular aneurysm sealing procedure performed at another center. Computed tomography angiography showed distal migration of a Nellix endoprosthesis (Endologix, Irvine, Calif) and a posterior contained rupture. The left kidney was excluded by an occluded iliac-left renal bypass, which was performed at the time of the Nellix implantation because of unintended coverage. A t-Branch (Cook Medical, Bloomington, Ind) was implanted in an emergency, but the delivery caused disruption of the Nellix limb, requiring relining. Target vessels were bridged with VBX stents (W. L. Gore & Associates, Flagstaff, Ariz). The postoperative course was uneventful except for renal function impairment that was restored 2 weeks later.

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“…The CTA was performed eight weeks after the second step for two step procedures, which were performed for spinal cord ischaemia risk reduction when at least one visceral branch was present in the endograft, or when the planned supracoeliac aortic coverage was >5 cm. 13 The second step was performed a maximum of four weeks after the first procedure. The patients were then submitted to the follow up protocol of general imaging, which includes a contrast enhanced ultrasound examination six months after the intervention and then yearly, and a CTA one year after the intervention and then biennially, in the absence of complications.…”

Section: Pre-operative Vascular Imaging Procedures and Follow Upmentioning

confidence: 99%

Early Renal Function Alterations in Renal Branches vs. Renal Fenestrations – A Dynamic Scintigraphy Based Prospective Study

Orrico

Cosma

Ricci

et al. 2020

European Journal of Vascular and Endovascular Surgery

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This single centre prospective study involved 67 patients treated by fenestrated and branched endovascular aneurysm repair (F/BEVAR) technology, who were divided into two groups depending on the renal bridging configurations (fenestration vs. branch). The renal outcomes were studies with standard laboratory parameters (serum creatinine levels and estimated glomerular filtration rate calculation with the Chronic Kidney Disease Epidemiology Collaboration equation) and with 99m Tc dynamic renal scintigraphy to determine whether the configurations have different effects on the renal function. It was found that branches were associated with a more significant decrease in the glomerular filtration rate already evident on three month renal scintigraphy and stable at one year.Objective: The objective of this prospective single centre study was to assess whether branches and fenestrations have different outcomes on renal function in the early phase. Methods: From March 2018 to June 2019, 67 patients who underwent elective fenestrated and branched endovascular aneurysm repair (F/BEVAR) procedures were enrolled in this study. The patients were divided into two groups according to the renal bridging component configuration (fenestration vs. branch). All of them underwent dynamic renal scintigraphy with 99m Tc diethylenetriaminepentaacetic acid (DTPA), two weeks pre-operatively, and three months and one year post-operatively. The primary end points were periprocedural technical success, 30 day major adverse events, differences in glomerular filtration rate (GFR) between the branch and fenestration configurations, and variations between the pre-operative and the postoperative dynamic renal scintigraphy. Results: Overall, 135 kidneys were analysed: 63 in the 32 patients treated with fenestrations, and 72 in the 35 patients treated with branches; the mean GFR on baseline scintigraphy was 58.4 AE 30.9 mL/min in the fenestration group, and 65.1 AE 29.2 mL/min in the branch group. Only kidneys associated with a patent fenestration/branch were included in the split GFR final analysis. The mean total GFR at three month scintigraphy decreased by 6.0 AE 2.9 mL/min in the fenestration group and by 23.4 AE 6.4 mL/min in the branch group. The split GFR decreased by 3.5 AE 0.6 mL/min in the fenestration group, and by 15.4 AE 5.4 mL/ min in the branch group. The GFR decrease remained stable at one year. Conclusion:In this study, the use of branches for renal arteries during F/BEVAR resulted in a greater decrease in the GFR than in those patients who were treated with fenestrations alone. The scintigraphic alterations were evident at an early phase.

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The “bare branch” for safe spinal cord ischemia prevention after total endovascular repair of thoracoabdominal aneurysms

Cited by 15 publications

References 22 publications

Prospective Assessment of a Protocol Using Neuromonitoring, Early Limb Reperfusion, and Selective Temporary Aneurysm Sac Perfusion to Prevent Spinal Cord Injury During Fenestrated-branched Endovascular Aortic Repair

Prospective Assessment of a Protocol Using Neuromonitoring, Early Limb Reperfusion, and Selective Temporary Aneurysm Sac Perfusion to Prevent Spinal Cord Injury During Fenestrated-branched Endovascular Aortic Repair

Late failure of a Nellix endoprosthesis treated with the t-Branch off-the-shelf multibranched stent graft

Early Renal Function Alterations in Renal Branches vs. Renal Fenestrations – A Dynamic Scintigraphy Based Prospective Study

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