Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm
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Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm. / Law, Yuk; Tsilimparis, Nikolaos; Rohlffs, Fiona; Makaloski, Vladimir; Behrendt, Christian-Alexander; Heidemann, Franziska; Wipper, Sabine Helena; Debus, Eike Sebastian; Kölbel, Tilo.
In: J VASC SURG, Vol. 70, No. 2, 08.2019, p. 404-412.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm
AU - Law, Yuk
AU - Tsilimparis, Nikolaos
AU - Rohlffs, Fiona
AU - Makaloski, Vladimir
AU - Behrendt, Christian-Alexander
AU - Heidemann, Franziska
AU - Wipper, Sabine Helena
AU - Debus, Eike Sebastian
AU - Kölbel, Tilo
N1 - Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2019/8
Y1 - 2019/8
N2 - OBJECTIVE: Fenestrated or branched endovascular aortic repair (FB-EVAR) usually represents the last stage in endovascular treatment of postdissection aneurysm after thoracic endograft coverage of entry tear and false lumen embolization.METHODS: The study was a retrospective analysis of all patients with postdissection thoracoabdominal aneurysm treated with FB-EVAR in a single center. Short-term outcomes included technical success, operative mortality, and morbidities. Midterm outcomes included secondary intervention, false lumen thrombosis rate, aneurysm size regression, and subsequent survival.RESULTS: Twenty patients (95% male with a mean age of 64 ± 9 years) were treated between January 2014 and December 2017. The technical success was 100%. There was one death (5%) within 30 days. Postoperative complications included two patients with spinal cord ischemia (10%; one partial and one full). The median follow-up period was 12 months (range, 0-31 months). A secondary intervention was required in six patients, including thoracic stent graft relining for type III endoleak (n = 2), covered stent relining for junctional leak between main body and renal stent (n = 2), and iliac false lumen embolization (n = 2). Twelve patients completed the 1-year follow-up computed tomography angiogram, and their mean aneurysm diameters were 71 ± 18, 66 ± 19, and 62 ± 19 mm preoperatively, immediate postoperatively, and at 1 year, respectively; the corresponding false lumen thrombosis rates were 0% (0/20), 58% (7/12), and 92% (11/12), respectively. One more patient died during follow-up from a non-aneurysm-related cause. The estimated overall survival rates were 95 ± 5%, 88 ± 8%, and 88 ± 8% at 6, 12, and 18 months, respectively.CONCLUSIONS: FB-EVAR was feasible for postdissection thoracoabdominal aneurysm. Despite the associated perioperative risk and high probability of planned or unplanned reintervention, the procedure led to favorable aortic remodeling with false lumen thrombosis and aneurysm regression.
AB - OBJECTIVE: Fenestrated or branched endovascular aortic repair (FB-EVAR) usually represents the last stage in endovascular treatment of postdissection aneurysm after thoracic endograft coverage of entry tear and false lumen embolization.METHODS: The study was a retrospective analysis of all patients with postdissection thoracoabdominal aneurysm treated with FB-EVAR in a single center. Short-term outcomes included technical success, operative mortality, and morbidities. Midterm outcomes included secondary intervention, false lumen thrombosis rate, aneurysm size regression, and subsequent survival.RESULTS: Twenty patients (95% male with a mean age of 64 ± 9 years) were treated between January 2014 and December 2017. The technical success was 100%. There was one death (5%) within 30 days. Postoperative complications included two patients with spinal cord ischemia (10%; one partial and one full). The median follow-up period was 12 months (range, 0-31 months). A secondary intervention was required in six patients, including thoracic stent graft relining for type III endoleak (n = 2), covered stent relining for junctional leak between main body and renal stent (n = 2), and iliac false lumen embolization (n = 2). Twelve patients completed the 1-year follow-up computed tomography angiogram, and their mean aneurysm diameters were 71 ± 18, 66 ± 19, and 62 ± 19 mm preoperatively, immediate postoperatively, and at 1 year, respectively; the corresponding false lumen thrombosis rates were 0% (0/20), 58% (7/12), and 92% (11/12), respectively. One more patient died during follow-up from a non-aneurysm-related cause. The estimated overall survival rates were 95 ± 5%, 88 ± 8%, and 88 ± 8% at 6, 12, and 18 months, respectively.CONCLUSIONS: FB-EVAR was feasible for postdissection thoracoabdominal aneurysm. Despite the associated perioperative risk and high probability of planned or unplanned reintervention, the procedure led to favorable aortic remodeling with false lumen thrombosis and aneurysm regression.
KW - Aged
KW - Aged, 80 and over
KW - Aneurysm, Dissecting/diagnostic imaging
KW - Aortic Aneurysm, Abdominal/diagnostic imaging
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Databases, Factual
KW - Embolization, Therapeutic/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Germany
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications/therapy
KW - Prosthesis Design
KW - Retreatment
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.jvs.2018.10.117
DO - 10.1016/j.jvs.2018.10.117
M3 - SCORING: Journal article
C2 - 30704800
VL - 70
SP - 404
EP - 412
JO - J VASC SURG
JF - J VASC SURG
SN - 0741-5214
IS - 2
ER -
