Akute komplexe endovaskuläre Aortenchirurgie – Off-the-Shelf vs. Surgeon-modified Stentgrafts

TY - JOUR

T1 - Akute komplexe endovaskuläre Aortenchirurgie – Off-the-Shelf vs. Surgeon-modified Stentgrafts

AU - Kapetanios, Dimitrios

AU - Stana, Jan

AU - Prendes, Carlota Fernandez

AU - Stavroulakis, Konstantinos

AU - Kölbel, Tilo

AU - Rantner, Barbara

AU - Tsilimparis, Nikolaos

N1 - Thieme. All rights reserved.

PY - 2021/10

Y1 - 2021/10

N2 - INTRODUCTION: Treatment of complex abdominal and thoracoabdominal aortic aneurysms is challenging. Open surgical repair is a high-risk operation, especially in emergency cases. Endovascular aneurysm repair with a patient-specific custom-made stent graft in patients with symptomatic or ruptured complex aortic aneurysms is not possible, due to the manufacturing time required. In such cases, alternative endovascular techniques can be used.RESULTS: The "off-the-shelf" and "surgeon-modified" stent grafts are valid options for the endovascular treatment of complex aneurysms in urgent and emergent patients. The former are standardised commercially manufactured fenestrated or branched stent grafts, which are available off-the-shelf with an anatomical feasibility in 50 - 80% of the patients. The "surgeon-modified" stent grafts refer to a technique, in which a commercially available stent graft is modified by the surgeon under sterile conditions directly before the implantation, in order to add the required fenestrations, scallops and/or branches. The modification takes approximately 60 - 120 min and haemodynamic stability of the patient is mandatory. Because of the off-label use of the commercial stent graft, detailed patient consent about the modification complications and risks should be performed whenever possible. A comparison of results on mortality and morbidity between "off-the-shelf" and "surgeon-modified" stent grafts has been published, although a direct comparison would be unfair for several reasons (different design, lack of extensive outcomes reports, long learning curve and different modification techniques).CONCLUSION: The "surgeon-modified" and "off-the-shelf" fenestrated/branched stent grafts are used in the treatment of high-risk patients with symptomatic or contained ruptured complex aneurysms. The outcomes of the two techniques are good, although the long-term durability of the former should be further investigated.

AB - INTRODUCTION: Treatment of complex abdominal and thoracoabdominal aortic aneurysms is challenging. Open surgical repair is a high-risk operation, especially in emergency cases. Endovascular aneurysm repair with a patient-specific custom-made stent graft in patients with symptomatic or ruptured complex aortic aneurysms is not possible, due to the manufacturing time required. In such cases, alternative endovascular techniques can be used.RESULTS: The "off-the-shelf" and "surgeon-modified" stent grafts are valid options for the endovascular treatment of complex aneurysms in urgent and emergent patients. The former are standardised commercially manufactured fenestrated or branched stent grafts, which are available off-the-shelf with an anatomical feasibility in 50 - 80% of the patients. The "surgeon-modified" stent grafts refer to a technique, in which a commercially available stent graft is modified by the surgeon under sterile conditions directly before the implantation, in order to add the required fenestrations, scallops and/or branches. The modification takes approximately 60 - 120 min and haemodynamic stability of the patient is mandatory. Because of the off-label use of the commercial stent graft, detailed patient consent about the modification complications and risks should be performed whenever possible. A comparison of results on mortality and morbidity between "off-the-shelf" and "surgeon-modified" stent grafts has been published, although a direct comparison would be unfair for several reasons (different design, lack of extensive outcomes reports, long learning curve and different modification techniques).CONCLUSION: The "surgeon-modified" and "off-the-shelf" fenestrated/branched stent grafts are used in the treatment of high-risk patients with symptomatic or contained ruptured complex aneurysms. The outcomes of the two techniques are good, although the long-term durability of the former should be further investigated.

KW - Aortic Aneurysm, Abdominal/surgery

KW - Aortic Aneurysm, Thoracic/surgery

KW - Blood Vessel Prosthesis

KW - Blood Vessel Prosthesis Implantation

KW - Endovascular Procedures

KW - Humans

KW - Postoperative Complications

KW - Prosthesis Design

KW - Stents

KW - Surgeons

KW - Treatment Outcome

U2 - 10.1055/a-1647-3549

DO - 10.1055/a-1647-3549

M3 - SCORING: Review

C2 - 34666365

VL - 146

SP - 521

EP - 527

JO - ZBL CHIR

JF - ZBL CHIR

SN - 0044-409X

IS - 5

ER -