Impact of alterations in target vessel curvature on branch durability after endovascular repair of thoracoabdominal aortic aneurysms

Purpose Bridging stent stability is crucial for efficacy and safety of branched aortic endovascular repair (bEVAR) of thoracoabdominal aortic aneurysms (TAAAs). In this study, we assess the performance of the new Viabahn Balloon-Expandable endoprosthesis (VBX) in bEVAR. Based on our learning curve we give recommendations for a safe and effective use of the device. Materials and Methods We prospectively collected the data of patients with TAAAs undergoing bEVAR between December 2017 and December 2019. All patients with implantation of at least 1 VBX stent-graft as bridging stent were included in our single-center analysis. Demographic, comorbidity, and computed tomography angiography (CTA) data of 112 patients were retrospectively evaluated. Primary endpoint was a composite of branch-related technical success and freedom from target vessel instability. Secondary endpoints were clinical and ongoing clinical success. Results Primary endpoint: technical success was achieved in all patients (100%) with a freedom from target vessel instability of 96.3% after a median follow-up of 18 months. Overall mortality was 13.4% (n=15) and 13 patients underwent secondary interventions, 12 of them are still alive and 1 suffered from aneurysm sac expansion, consequently an ongoing clinical success of 75.9% was reached. After modification of the implantation technique during the course of the study by selecting longer stent lengths after accurate estimation of vessel curvature and expected adaptation of the flexible endoskeleton to the specific anatomical conditions, no type Ic endoleaks were observed in the last 70 cases. Conclusions The VBX stent-graft can be safely used as bridging stent for branched thoracoabdominal repair. However, learning curve should be considered to avoid type Ic endoleak and edge stenosis. Based on this experience longer landing zones and 2-step deployment of VBX are useful for successful bridging also of challenging target vessels.

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Stents for the Treatment of Aortic Aneurysms

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615578 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 171-175 ◽

Cited By ~ 1

Author(s):

D. Ebert ◽

M. Langer ◽

P. Uhrmeister

Keyword(s):

Endovascular Treatment ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Imaging Modalities ◽

Exclusion Criteria ◽

Multicenter Studies ◽

Abdominal Aortic ◽

First Results

SummaryThe endovascular treatment of abdominal aortic aneurysms has generated a great deal of interest since the early 1990s, and many different devices are currently available. The procedure of endovascular repair has been evaluated in many institutions and the different devices are compared. The first results were encouraging, but complications like endoleak, dislocation or thrombosis of the graft occurred. By the available devices the stent application is only promising, if the known exclusion criteria are strictly respected. Therefore a careful preinterventional assessment of the patient by different imaging modalities is necessary. As the available results up to now are preliminary and the durability of the devices has to be controlled, multicenter studies are required to improve the devices and observe their long- term success in the exclusion of abdominal aortic aneurysms.

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The Clinical and Fiscal Impact of Endovascular Repair of Abdominal Aortic Aneurysms

The Heart Surgery Forum ◽

10.1532/hsf98.20041070 ◽

2004 ◽

Vol 7 (5) ◽

pp. E503-E507 ◽

Cited By ~ 1

Author(s):

Daniel R. Watson ◽

Thomas Tan ◽

Lori Wiseman ◽

Gary M. Ansel ◽

Chip Botti ◽

...

Keyword(s):

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Fiscal Impact ◽

Abdominal Aortic

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Oblique Groin Incision for Endovascular Repair of Abdominal Aortic Aneurysms

The Heart Surgery Forum ◽

10.1532/hsf98.2004-1069 ◽

2004 ◽

Vol 7 (5) ◽

pp. E515-E518 ◽

Cited By ~ 15

Author(s):

Daniel R. Watson ◽

Thomas Tan ◽

Lori Wiseman ◽

Gary M. Ansel ◽

Chip Botti ◽

...

Keyword(s):

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic

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Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

The Heart Surgery Forum ◽

10.1532/hsf98.2014315 ◽

2014 ◽

Vol 17 (3) ◽

pp. 146

Author(s):

Osman Tansel Darcin ◽

Mehmet Kalender ◽

Ayse Gul Kunt ◽

Okay Guven Karaca ◽

Ata Niyazi Ecevit ◽

...

Keyword(s):

Endovascular Repair ◽

Therapeutic Option ◽

Complete Recovery ◽

Aortic Aneurysms ◽

Thoracoabdominal Aorta ◽

Mortality And Morbidity ◽

Early Results ◽

The Mean ◽

Procedural Success

Background: Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.Methods: From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.Results: All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.Conclusion: Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.

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