TCT-595: Aorto-Uniliac Vs Bifurcated Endovascular Aortic Repair: Technical Success, Secondary Intervention Rate and Quality-adjusted cost analysis

Objective Despite endovascular advances in fenestrated and branched devices, thoracic endovascular aortic repair (TEVAR) for arch pathologies remains challenging. The aim of this study was to provide a contemporary review on the current evidence for in situ fenestration during TEVAR and to evaluate its short- and mid-term clinical outcome in the management of arch pathology. Methods A systematic literature review on in situ fenestration of thoracic aortic stent-graft from January 2003 to September 2018 was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results Our initial search yielded 169 studies, of which 21 articles were relevant to the topic and were finally included. One hundred and forty-five in situ fenestration procedures in 99 patients were reviewed, involving 25 innominate arteries (17%), 33 left common carotid arteries (23%) and 87 left subclavian arteries (60%). Twelve patients (12/99, 12%) had two-vessel fenestration and three-vessel fenestration was performed in 17 patients (17/99, 17%). Technical success was achieved in 136 arteries (136/145, 93%). Talent/Valiant with monofilament twill woven polyester fabric was the most common (50/99, 51%) stent-graft used for fenestration. Three methods reported for in situ fenestration were needle, laser and radiofrequency. Needle was the most frequently used device for fenestration, which was performed in 60 patients (60/99, 61%). Three patients (3/99, 3%) died with 30 days, none were in situ fenestration TEVAR procedure-related. Perioperative complications including one (1%) retrograde type A aortic dissection, two (2%) type II endoleaks, and three (3%) strokes were reported. The pooled estimate for overall technical success, perioperative mortality and stroke was 88.3% (95% CI, 78.6%–93.9%), 5.9% (95% CI, 2.5%–13.4%) and 9.5% (95% CI, 4.1%–20.6%), respectively. Four patients (4/96, 4%) died during follow-up, none were aortic-related. All the fenestration bridging stents were reportedly patent, with only 1 (1/96, 1%) asymptomatic left subclavian stent stenosis. Two patients (2/96, 2%) with type II endoleak from left subclavian artery required secondary intervention. Conclusion In situ fenestration appeared to be a feasible and effective method to extend proximal landing zone during TEVAR. It had an acceptable short-term result with high technical success and low fenestration related morbidity. Long-term durability data were lacking, and there was no high level evidence to recommend the routine use of in situ fenestration TEVAR for the management of arch pathology.

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Functional Outcome and Mortality After Open and Endovascular Secondary Intervention for Thoracic Endovascular Aortic Repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.11.022 ◽

2013 ◽

Vol 57 (1) ◽

pp. 293-294

Author(s):

Khayree Butler ◽

Salvatore T. Scali ◽

Adam W. Beck ◽

Robert J. Feezor ◽

Peter R. Nelson ◽

...

Keyword(s):

Functional Outcome ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Secondary Intervention ◽

Aortic Repair

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Thoracic Endovascular Aortic Repair (TEVAR): A Case Report

Bangladesh Heart Journal ◽

10.3329/bhj.v34i2.44447 ◽

2019 ◽

Vol 34 (2) ◽

pp. 146-150

Author(s):

GM Mokbul Hossain ◽

AHM Bashar ◽

Mohammad Enamul Hakim ◽

Md Fidah Hossain ◽

Nirmal Kanti Dey ◽

...

Keyword(s):

Common Iliac Artery ◽

The Elderly ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Technical Success ◽

Imaging Studies ◽

Catheterization Laboratory ◽

Cardiac Catheterization Laboratory ◽

Aortic Repair ◽

The Common

Thoracic aortic aneurysm (TAA) is generally a disease of the elderly which remains mostly asymptomatic. It is often detected incidentally with imaging studies of the chest done for other reasons. We present a 55year-old smoker, normotensive and non-diabetic male patient who was diagnosed as a case of TAA and treated by endovascular means with thoracic endovascular aortic repair (TEVAR) technique. Due to small caliber femoral artery, thoracic endograft was deployed through a Dacron graft conduit of 10 mm diameter which was anastomosed to the common iliac artery. It was a hybrid procedure done in cardiac catheterization laboratory under general anesthesia. Completion angiogram revealed good technical success with no endoleak or neurological deficit. Patient improved symptomatically after TEVAR. Bangladesh Heart Journal 2019; 34(2) : 146-150

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Preliminary Outcomes of Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Renal Arteries During Fenestrated Endovascular Aortic Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211012403 ◽

2021 ◽

pp. 152660282110124

Author(s):

Luca Mezzetto ◽

Davide Mastrorilli ◽

Nicola Leone ◽

Stefano Gennai ◽

Roberto Silingardi ◽

...

Keyword(s):

Renal Artery ◽

Endovascular Aneurysm Repair ◽

Renal Arteries ◽

Endovascular Aortic Repair ◽

Type I ◽

Target Vessel ◽

Technical Success ◽

Transverse Axis ◽

Aortic Repair

Purpose: To report preliminary outcomes of Viabahn Balloon-Expandable Endoprosthesis (VBX) stent-graft as bridging stent for renal arteries in fenestrated endovascular aneurysm repair (FEVAR). Materials and Methods: Between 2018 and 2019, patients undergoing FEVAR at 3 referral Italian university hospitals were prospectively collected. During the study period, VBX was the first-line choice as bridging stent for renal arteries. Procedural and anatomical data were analyzed, including renal artery (RA) configuration. A dedicated software (3Mensio, Vascular Imaging, Bilthoeven, The Netherlands) was used and RA anatomy classified as follow: upward-oriented in case of any angle >30° above the horizontal or transverse axis perpendicular to the aortic axis, downward-oriented if there was an angle >30° measured below the transverse axis and downward + upward in case of an angle <30° associated with a renal artery angulation >90°. Primary endpoints were technical success, defined as complete deployment of the fenestrated endograft without target vessel (TV) loss, limb stenosis or occlusion and type I or III endoleak, and freedom from target artery instability (TAI), defined by target vessel-related death, occlusion, rupture or reintervention for stenosis, endoleak or disconnection. Secondary endpoints were target artery patency rate and freedom from reinterventions. Results: A total of 26 elective FEVAR for juxta/pararenal aneurysm (20), thoracoabdominal type II (3) and type IV (3) were included. Fifty-one RA were planned for revascularization. Of these, 32 were downward, 10 horizontal, 6 upward, 4 were downward + upward. Technical success was achieved in 88.5% (23/26) of patients and 94.2% (48/51) of the TVs. One occlusion (2.1%) occurred within 30 days in a patient with previous endovascular aortic repair and suprarenal fixation. During follow-up (median 10 months), there was 1 type IC endoleak after 6 months (2.1%) in a patient with upward plus downward arterial orientation. Freedom from TAI was 96.1% (CI = 0.89 to 1.04) at first month and 92.3% (CI = 0.82 to 1.03) at 6 months. No aneurysm-related mortality and renal insufficiency occurred during follow-up. Conclusion: The use of VBX as bridging stent of RA in FEVAR is safe and feasible. Previous EVAR and tortuosity of RA may be a challenging on target vessel fate.

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Valiant NAVION Stent Graft System Application: First Asian Case Series Analysis

10.22541/au.160700484.46121257/v1 ◽

2020 ◽

Author(s):

Chi Ying Simon Chow ◽

Yan Kit Ho ◽

Takuya Fujikawa ◽

Kevin Lim ◽

Cheuk Man Chu ◽

...

Keyword(s):

Hospital Stay ◽

Stent Graft ◽

Case Series ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Technical Success ◽

Term Survival ◽

Aortic Repair ◽

The Mean ◽

Aortic Pathologies

Background and aim of the study The Valiant NavionTM stent graft system is a third-generation low profile thoracic endograft designed for thoracic endovascular aortic repair. In this population analysis, we report on the first Asian all-comers experience and outcomes who underwent thoracic endovascular aortic repair with the use of this new stent graft system. Methods Between May 2019 and October 2020, 21 patients with different aortic pathologies were prospectively recruited and retrospectively analyzed. Important clinical and device-related outcomes were evaluated. The endpoints included short-term survival, technical success, access failures, major vascular and clinical complications, endoleaks, and hospital stay. Results The commonest indication of stenting was penetrating aortic ulcers (28.6%) and 6 (28.6%) patients had emergency stenting performed for aortic transection or rupture. 30 days of survival post-procedure was recorded and complete. There were no major vascular complications. Deployment accuracy was 100%, and the technical success rate was 94.7% (18/19) with 1 patient having a type 2 endoleak on follow-up imaging. No neurological complications were noted. The mean operative time was 95 +/- 73.6 mins and the mean fluoroscopy time was 16.2 +/- 10.8 mins. Mean hospital stay for elective zone 2, 3 and 4 stenting was 5.3 +/- 3.8 days, and only 1 patient post zone 1 TEVAR required a brief (0.5 days) ICU stay. All procedures were performed via the percutaneous transfemoral route with 100% success in percutaneous closure. Conclusion This first reported Asian case series demonstrated versatility, safety, and efficacy of the Valiant NavionTM stent in Asian patients with different aortic pathologies

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Comparative Cost Analysis of Ambulatory Versus In-Patient Endovascular Aortic Repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.08.018 ◽

2021 ◽

Vol 74 (5) ◽

pp. e432

Author(s):

Ahmed A. Naiem ◽

R.J. Doonan ◽

Kent S. MacKenzie ◽

Oren K. Steinmetz ◽

Daniel I. Obrand ◽

...

Keyword(s):

Cost Analysis ◽

Endovascular Aortic Repair ◽

Comparative Cost ◽

Aortic Repair

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Systematic review with pooled data analysis reveals the need for a standardized reporting protocol including the visceral vessels during fenestrated endovascular aortic repair (FEVAR)

Vascular ◽

10.1177/17085381211019148 ◽

2021 ◽

pp. 170853812110191

Author(s):

Georgios I Karaolanis ◽

Constantine N Antonopoulos ◽

Salvatore Scali ◽

Stylianos G Koutsias ◽

Drosos Kotelis ◽

...

Keyword(s):

Meta Analysis ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Type I ◽

Complication Rates ◽

Technical Success ◽

Aortic Repair ◽

Standardized Reporting ◽

Related Mortality

Objectives To collect and analyse the available evidence in the outcomes of patients treated with fenestrated endovascular aortic repair (f-EVAR) technique focusing specifically on visceral vessel outcomes. Methods The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the studies reporting the f-EVAR technique for the management of degenerative pararenal and/or type IV thoracoabdominal aortic aneurysms (TAAA) were considered eligible for inclusion in the study. The main study outcomes (technical success, type I endoleaks, fracture or occlusion of the bridging stents, overall aneurysm-related mortality, and the reintervention rate) were subsequently expressed as proportions and 95% confidence intervals. Results Fourteen studies with a total of 1804 patients were included in a pooled analysis. The technical success of the procedure was 95.97% (95%CI = 92.35–98.60). Intraoperatively, the pooled proportion of reported type I endoleak was 7.6% (95%CI = 2.52–14.60) while during a median follow-up of 41 months (range 11–96) follow-up period the pooled rate of fracture and occlusion of the bridging stents was 2.79% (95%CI = 0.00–8.52) and 4.46% (95%CI = 1.93–7.77), respectively. The overall aneurysm-related mortality was detected to be 0.63% (95%CI = 0.04–1.63), and the pooled estimate for re-intervention rate was 15.69%. Conclusions Fenestrated endovascular repair for p-AAA is an effective and safe treatment. Target vessel complications and endoleaks remain the two most important concerns for fenestrated endovascular procedures, contributing to most of the secondary interventions. The lack of computed tomography angiography follow-up evaluation does not allow us to draw robust conclusions about the complication rates for the superior mesenteric artery during f-EVAR. Due to the potential implications of SMA complications on aneurysm-related mortality, standardized reporting of short- and long-term target visceral vessel outcomes is required.

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