Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair

Nikolas Tsilimparis; Sebastian E Debus; Max Biehl; Konstantinos Spanos; Axel Larena-Avellaneda; Sabine Wipper; Fiona Rohlffs; Tilo Kölbel

doi:10.1016/j.jvs.2017.09.049

Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair

Standard

Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair. / Tsilimparis, Nikolas; Debus, Sebastian E; Biehl, Max; Spanos, Konstantinos; Larena-Avellaneda, Axel; Wipper, Sabine; Rohlffs, Fiona; Kölbel, Tilo.

in: J VASC SURG, Jahrgang 67, Nr. 6, 06.2018, S. 1684-1689.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Tsilimparis, N, Debus, SE, Biehl, M, Spanos, K, Larena-Avellaneda, A, Wipper, S, Rohlffs, F & Kölbel, T 2018, 'Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair', J VASC SURG, Jg. 67, Nr. 6, S. 1684-1689. https://doi.org/10.1016/j.jvs.2017.09.049

APA

Tsilimparis, N., Debus, S. E., Biehl, M., Spanos, K., Larena-Avellaneda, A., Wipper, S., Rohlffs, F., & Kölbel, T. (2018). Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair. J VASC SURG, 67(6), 1684-1689. https://doi.org/10.1016/j.jvs.2017.09.049

Vancouver

Tsilimparis N, Debus SE, Biehl M, Spanos K, Larena-Avellaneda A, Wipper S et al. Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair. J VASC SURG. 2018 Jun;67(6):1684-1689. https://doi.org/10.1016/j.jvs.2017.09.049

Bibtex

@article{d32c4ff65ee9440aad12c1ef12895772,

title = "Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair",

abstract = "OBJECTIVE: The aim of this study was to assess the immediate postoperative and midterm outcome of complex aortic aneurysm treatment necessitating four-vessel revascularization with either a total endovascular approach (fenestrated-branched stent graft [FBSG]) or a hybrid technique of visceral debranching plus stenting.METHODS: The clinical data of consecutively treated patients presenting with a complex aortic aneurysm that necessitated four-vessel revascularization between 2010 and 2015 were retrospectively analyzed.RESULTS: There were 98 patients (65 men [68%]) with a mean age of 70.65 ± 4 years who presented with aortic aneurysm (Crawford type I, 12; type II, 18; type III, 12; type IV, 24; type V, 6; and juxtarenal and suprarenal, 26) and were treated with either FBSG (76/98 [77.5%]) or hybrid repair (22/98 [22.4%]). Twenty-six patients were symptomatic (16, pain; 10, contained rupture). The mean maximum aneurysm diameter was 65 ± 15 mm, and 53% of the patients had a prior aortic intervention. In FBSG-treated patients, 15 off-the-shelf multibranched stent grafts, 3 surgeon-modified fenestrated stent grafts, and 58 custom-made devices tailored to the patient's anatomy were used. Four fenestrations, four branches, and their combination were used in 38 cases, 30 cases, and 8 cases, respectively. A total of 304 target vessels were addressed, with technical success rate of 96% (292/304). In most hybrid cases (18/22 [82%]), a two-stage procedure was undertaken. All target vessels were successfully revascularized with 88 bypasses. The 30-day mortality was 15.3% (15/98), and the early target vessel occlusion was 9.1% (2 in FBSG, 7 in hybrid). After multivariate analysis, type of procedure (hybrid) was independently associated with higher early mortality (odds ratio, 6.3; P = .01). The morbidity was mainly attributed to pulmonary complications (16.3%), lower extremity weakness (16.3%), mesenteric ischemia (6.1%), dialysis on discharge (6.1%), and complete paraplegia (4.3%). Acute renal failure (2.6% vs 18%; P = .03) and mesenteric ischemia (3% vs 23%; P = .001) presented more commonly in the hybrid group. The mean follow-up was 16.4 ± 5 months, and the mortality rate was 19.4% (12% in the FBSG group vs 45% in the hybrid group; P = .05). The graft and stent graft patency rate was 87.8% (three branches and nine bypasses were occluded).CONCLUSIONS: FBSG and hybrid technique seem to be feasible treatment options for complex aortic aneurysms that necessitate four-vessel revascularization. FBSG may be associated with lower mortality and morbidity rates in comparison to the hybrid procedure. FBSG should be the treatment of choice for complex aneurysms in patients with comorbidities, whereas hybrid repair should be considered for acute cases unsuitable for endovascular repair.",

keywords = "Aged, Aortic Aneurysm/diagnosis, Blood Vessel Prosthesis, Endovascular Procedures/methods, Feasibility Studies, Female, Follow-Up Studies, Germany/epidemiology, Humans, Incidence, Male, Postoperative Complications/epidemiology, Prosthesis Design, Retrospective Studies, Risk Factors, Stents, Survival Rate/trends, Treatment Outcome",

author = "Nikolas Tsilimparis and Debus, {Sebastian E} and Max Biehl and Konstantinos Spanos and Axel Larena-Avellaneda and Sabine Wipper and Fiona Rohlffs and Tilo K{\"o}lbel",

year = "2018",

month = jun,

doi = "10.1016/j.jvs.2017.09.049",

language = "English",

volume = "67",

pages = "1684--1689",

journal = "J VASC SURG",

issn = "0741-5214",

publisher = "Mosby Inc.",

number = "6",

}

RIS

TY - JOUR

T1 - Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair

AU - Tsilimparis, Nikolas

AU - Debus, Sebastian E

AU - Biehl, Max

AU - Spanos, Konstantinos

AU - Larena-Avellaneda, Axel

AU - Wipper, Sabine

AU - Rohlffs, Fiona

AU - Kölbel, Tilo

PY - 2018/6

Y1 - 2018/6

N2 - OBJECTIVE: The aim of this study was to assess the immediate postoperative and midterm outcome of complex aortic aneurysm treatment necessitating four-vessel revascularization with either a total endovascular approach (fenestrated-branched stent graft [FBSG]) or a hybrid technique of visceral debranching plus stenting.METHODS: The clinical data of consecutively treated patients presenting with a complex aortic aneurysm that necessitated four-vessel revascularization between 2010 and 2015 were retrospectively analyzed.RESULTS: There were 98 patients (65 men [68%]) with a mean age of 70.65 ± 4 years who presented with aortic aneurysm (Crawford type I, 12; type II, 18; type III, 12; type IV, 24; type V, 6; and juxtarenal and suprarenal, 26) and were treated with either FBSG (76/98 [77.5%]) or hybrid repair (22/98 [22.4%]). Twenty-six patients were symptomatic (16, pain; 10, contained rupture). The mean maximum aneurysm diameter was 65 ± 15 mm, and 53% of the patients had a prior aortic intervention. In FBSG-treated patients, 15 off-the-shelf multibranched stent grafts, 3 surgeon-modified fenestrated stent grafts, and 58 custom-made devices tailored to the patient's anatomy were used. Four fenestrations, four branches, and their combination were used in 38 cases, 30 cases, and 8 cases, respectively. A total of 304 target vessels were addressed, with technical success rate of 96% (292/304). In most hybrid cases (18/22 [82%]), a two-stage procedure was undertaken. All target vessels were successfully revascularized with 88 bypasses. The 30-day mortality was 15.3% (15/98), and the early target vessel occlusion was 9.1% (2 in FBSG, 7 in hybrid). After multivariate analysis, type of procedure (hybrid) was independently associated with higher early mortality (odds ratio, 6.3; P = .01). The morbidity was mainly attributed to pulmonary complications (16.3%), lower extremity weakness (16.3%), mesenteric ischemia (6.1%), dialysis on discharge (6.1%), and complete paraplegia (4.3%). Acute renal failure (2.6% vs 18%; P = .03) and mesenteric ischemia (3% vs 23%; P = .001) presented more commonly in the hybrid group. The mean follow-up was 16.4 ± 5 months, and the mortality rate was 19.4% (12% in the FBSG group vs 45% in the hybrid group; P = .05). The graft and stent graft patency rate was 87.8% (three branches and nine bypasses were occluded).CONCLUSIONS: FBSG and hybrid technique seem to be feasible treatment options for complex aortic aneurysms that necessitate four-vessel revascularization. FBSG may be associated with lower mortality and morbidity rates in comparison to the hybrid procedure. FBSG should be the treatment of choice for complex aneurysms in patients with comorbidities, whereas hybrid repair should be considered for acute cases unsuitable for endovascular repair.

AB - OBJECTIVE: The aim of this study was to assess the immediate postoperative and midterm outcome of complex aortic aneurysm treatment necessitating four-vessel revascularization with either a total endovascular approach (fenestrated-branched stent graft [FBSG]) or a hybrid technique of visceral debranching plus stenting.METHODS: The clinical data of consecutively treated patients presenting with a complex aortic aneurysm that necessitated four-vessel revascularization between 2010 and 2015 were retrospectively analyzed.RESULTS: There were 98 patients (65 men [68%]) with a mean age of 70.65 ± 4 years who presented with aortic aneurysm (Crawford type I, 12; type II, 18; type III, 12; type IV, 24; type V, 6; and juxtarenal and suprarenal, 26) and were treated with either FBSG (76/98 [77.5%]) or hybrid repair (22/98 [22.4%]). Twenty-six patients were symptomatic (16, pain; 10, contained rupture). The mean maximum aneurysm diameter was 65 ± 15 mm, and 53% of the patients had a prior aortic intervention. In FBSG-treated patients, 15 off-the-shelf multibranched stent grafts, 3 surgeon-modified fenestrated stent grafts, and 58 custom-made devices tailored to the patient's anatomy were used. Four fenestrations, four branches, and their combination were used in 38 cases, 30 cases, and 8 cases, respectively. A total of 304 target vessels were addressed, with technical success rate of 96% (292/304). In most hybrid cases (18/22 [82%]), a two-stage procedure was undertaken. All target vessels were successfully revascularized with 88 bypasses. The 30-day mortality was 15.3% (15/98), and the early target vessel occlusion was 9.1% (2 in FBSG, 7 in hybrid). After multivariate analysis, type of procedure (hybrid) was independently associated with higher early mortality (odds ratio, 6.3; P = .01). The morbidity was mainly attributed to pulmonary complications (16.3%), lower extremity weakness (16.3%), mesenteric ischemia (6.1%), dialysis on discharge (6.1%), and complete paraplegia (4.3%). Acute renal failure (2.6% vs 18%; P = .03) and mesenteric ischemia (3% vs 23%; P = .001) presented more commonly in the hybrid group. The mean follow-up was 16.4 ± 5 months, and the mortality rate was 19.4% (12% in the FBSG group vs 45% in the hybrid group; P = .05). The graft and stent graft patency rate was 87.8% (three branches and nine bypasses were occluded).CONCLUSIONS: FBSG and hybrid technique seem to be feasible treatment options for complex aortic aneurysms that necessitate four-vessel revascularization. FBSG may be associated with lower mortality and morbidity rates in comparison to the hybrid procedure. FBSG should be the treatment of choice for complex aneurysms in patients with comorbidities, whereas hybrid repair should be considered for acute cases unsuitable for endovascular repair.

KW - Aged

KW - Aortic Aneurysm/diagnosis

KW - Blood Vessel Prosthesis

KW - Endovascular Procedures/methods

KW - Feasibility Studies

KW - Female

KW - Follow-Up Studies

KW - Germany/epidemiology

KW - Humans

KW - Incidence

KW - Male

KW - Postoperative Complications/epidemiology

KW - Prosthesis Design

KW - Retrospective Studies

KW - Risk Factors

KW - Stents

KW - Survival Rate/trends

KW - Treatment Outcome

U2 - 10.1016/j.jvs.2017.09.049

DO - 10.1016/j.jvs.2017.09.049

M3 - SCORING: Journal article

C2 - 29502996

VL - 67

SP - 1684

EP - 1689

JO - J VASC SURG

JF - J VASC SURG

SN - 0741-5214

IS - 6

ER -