The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms

Rastogi, Vinamr; Marcaccio, Christina L.; Kim, Nicole J.; Patel, Priya; Anjorin, Aderike C.; Zettervall, Sara L.; Patel, Virendra I.; Bruin, Jorg L. de; Verhagen, Hence J.M.; Schermerhorn, Marc L.

doi:10.1016/j.jvs.2022.08.007

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…After reviewing full texts, 34 articles were considered as relevant and 15 were finally included in the scoping review ( Figure 1 ). Briefly, 11 papers focused on EVAR [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ], 3 on FEVAR [ 15 , 16 , 17 ], and 1 on EVAR and FEVAR [ 18 ], including elective and non-elective presentations. Overall, we included 2574 subjects of which 2361 received EVAR and 213 received FEVAR, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Measurements at the level at the proximal edge of the stent graft and of other fixed graft markers were also described. Crude values at the level of interest [ 8 , 11 , 13 , 14 , 16 , 17 ] or an average between different levels [ 4 , 5 , 6 , 7 , 10 , 15 , 18 ] were reported to describe the metric details of the PAN.…”

Section: Resultsmentioning

confidence: 99%

“…In the FEVAR group, all studies reported outcomes after 3 years from the index procedure with only one study that extended data after 4 years [ 18 ]. Four studies analyzed PAN after FEVAR [ 15 , 16 , 17 , 18 ]. Among 84 patients with available CTA in the study by Rastogi et al, the median PND was 9.5% (IQR, 4.6–18.3%), and PND of >10% and >20% at the level of the first covered stent was found in 47.6% and in 20.2%, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…At 3 and 5 years, freedom from excessive dilatation was 92.3% (95% CI, 85.9–99.1%) and 81.6% (95% CI, 69.7–95.5%), respectively [ 15 ]. When compared with EVAR subgroups, FEVAR demonstrated the least neck dilation and the greatest degree of sac regression (FEVAR, 15.9%; Endurant, 6.5%; Excluder, 3.0%; Zenith, 3.4%; p = 0.009) [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

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A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Mezzetto

D’Oria

Lepidi

et al. 2023

JCM

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Background: To define proximal neck dilation (PND) after standard endovascular aneurysm repair (EVAR) and fenestrated EVAR (FEVAR), determining: incidence and risk factors; evidence base that links PND to outcomes of patients; recurring themes or gaps in the literature. Methods: We performed a scoping review and included only full-text English articles with follow-up focusing on PND in patients undergoing EVAR or FEVAR, published between 2000 and 2022. The following PICO question was used to build the search equation: in patients with abdominal-aortic-aneurysm (AAA) (Population) undergoing endovascular repair (Intervention), what are the incidence, risk factors and prognosis of radiologically defined PND (Comparison) on short-term and long-term outcomes (Outcomes)? Results: 15 articles were included after review. Measurement protocols for proximal aortic neck (PAN) varied among individual studies and the definition of PND resulted as heterogeneous. Rate of patients with a PND ranged between 0% and 41%. Large proximal neck (>28 mm) and excessive graft sizing (30%) were predictors for PND. New endografts with low outward radial forces and FEVAR seemed to be protective. Surgical conversion was the definitive option in the case of patients unfit for other endovascular treatments. Conclusions: PND is a frequent finding after EVAR and FEVAR. Excessive graft oversizing and large baseline PAN were predictors of neck enlargement, independently by the type of standard endograft used. FEVAR may be considered protective against complications, together with endografts using low outward radial forces. Lifelong radiological follow-up is mandatory.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Mezzetto

D’Oria

Lepidi

et al. 2023

JCM

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“…Currently, comprehensive and dedicated data on SMA results are lacking, and this absence of data is relevant since most recent FB-EVAR experiences report a wide use of 3–4 fenestrated (or branched) endograft configurations ( 20 ). Even though these designs ensure a safe and reliable proximal sealing zone in CAAAs over long-term follow-up, they also may create potential and life-threatening complications in the case of serious SMA-related adverse events ( 20 – 22 ).…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery-related outcomes in fenestrated/branched endografting for complex aortic aneurysms

Gallitto,

Faggioli,

Vacirca

et al. 2023

Front. Cardiovasc. Med.

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AimEarly/follow-up durability of superior mesenteric artery (SMA) stent-grafts is crucial after fenestrated/branched endografting (FB-EVAR) in complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). The study aimed to report early/midterm outcomes of SMA incorporated during FB-EVAR procedures.MethodsFB-EVAR procedures performed between 2016 and 2021 in a single institution were reviewed. Anatomical SMA characteristics were analyzed. The SMA configuration was classified into three types according to the angle between the SMA main trunk and the aorta: (A) perpendicular, (B) downward, and (C) upward. SMA-related technical success (SMA-TS: cannulation and stenting, patency at completion angiography without endoleak, stenosis/kinking, dissection, bleeding, and 24-h mortality) and SMA-adverse events (SMA-AEs: one among bowel ischemia, stenosis, occlusion, endoleak, reinterventions, or SMA-related mortality) were assessed.ResultsTwo hundred FB-EVAR procedures with SMA as the target artery were performed. The indication for FB-EVAR was CAAAs and TAAAs in 99 (49%) and 101 (51%) cases, respectively. The SMA configuration was A, B, and C in 132 (66%), 63 (31%), and 5 (3%) cases, respectively. SMA was incorporated with fenestrations and branches in 131 (66%) and 69 (34%) cases, respectively. Directional branch (P < .001), aortic diameter ≥35 mm at the SMA level (P < .001), and ≥2 SMA bridging stent-grafts (P = .001) were more frequent in TAAAs. Relining of the SMA stent-graft with a bare metal stent was necessary in 41 (21%) cases to correct an acute angle between the stent-graft and native artery (39), stent-graft stenosis (1), or SMA dissection (1). Relining was associated with type A or C SMA configuration (OR: 17; 95% CI: 1.8–157.3; P = .01). SMA-TS was achieved in all cases. Overall, 15 (7.5%) patients had SMA-AEs [early: 9 (60%), follow-up: 6 (40%)] due to stenosis (2), endoleak (8), and bowel ischemia (5). Aortic diameter ≥35 mm at the SMA level was an independent risk factor for SMA-AEs (OR: 4; 95% CI: 1.4–13.8; P = .01). Fourteen (7%) patients died during hospitalization with 10 (5%) events within the 30-postoperative day. Emergency cases (OR: 33; 95% CI: 5.7–191.3; P = .001), peripheral arterial occlusive disease (OR: 14; 95% CI: 2.3–88.8; P = .004), and bowel ischemia (OR: 41; 95% CI: 1.9–87.9; P = .01) were risk factors for 30-day/in-hospital mortality. The mean follow-up was 32 ± 24 months; estimated 3-year survival was 81%, with no case of late SMA-related mortality or occlusion. The estimated 3-year freedom from overall and SMA-related reinterventions was 74% and 95%, respectively.ConclusionSMA orientation determines the necessity of stent-graft relining. Aortic diameter ≥35 mm at the SMA level is a predictor of SMA-AEs. Nevertheless, SMA-related outcomes of FB-EVAR are satisfactory, with excellent technical success and promising clinical outcomes during the follow-up.

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Clinical presentation, outcomes, and threshold for repair by sex in degenerative saccular vs fusiform aneurysms in the descending thoracic aorta

Rastogi,

Guetter,

Patel

et al. 2023

Journal of Vascular Surgery

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The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms

Cited by 6 publications

References 29 publications

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

Superior mesenteric artery-related outcomes in fenestrated/branched endografting for complex aortic aneurysms

Clinical presentation, outcomes, and threshold for repair by sex in degenerative saccular vs fusiform aneurysms in the descending thoracic aorta

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