Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm

Yuk Law; Tilo Kölbel; Fiona Rohlffs; Christian Behrendt; Franziska Heidemann; Eike Sebastian Debus; Nikolaos Tsilimparis

doi:10.1016/j.jvs.2018.04.052

Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm

Standard

Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm. / Law, Yuk; Kölbel, Tilo; Rohlffs, Fiona; Behrendt, Christian; Heidemann, Franziska; Debus, Eike Sebastian; Tsilimparis, Nikolaos.

In: J VASC SURG, Vol. 69, No. 2, 02.2019, p. 334-340.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Law, Y, Kölbel, T, Rohlffs, F, Behrendt, C, Heidemann, F, Debus, ES & Tsilimparis, N 2019, 'Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm', J VASC SURG, vol. 69, no. 2, pp. 334-340. https://doi.org/10.1016/j.jvs.2018.04.052

APA

Law, Y., Kölbel, T., Rohlffs, F., Behrendt, C., Heidemann, F., Debus, E. S., & Tsilimparis, N. (2019). Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm. J VASC SURG, 69(2), 334-340. https://doi.org/10.1016/j.jvs.2018.04.052

Vancouver

Law Y, Kölbel T, Rohlffs F, Behrendt C, Heidemann F, Debus ES et al. Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm. J VASC SURG. 2019 Feb;69(2):334-340. https://doi.org/10.1016/j.jvs.2018.04.052

Bibtex

@article{6e65e3d0a8084f0b842003f766d17845,

title = "Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm",

abstract = "OBJECTIVE: Manufacturers often recommend the iliac arteries as the distal landing zone in fenestrated or branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aneurysm. It is not uncommon to choose distal landing at the infrarenal aorta for preservation of lumbar arteries or the inferior mesenteric artery (IMA); however, the safety and durability of this procedure have not been verified in the literature.METHODS: Consecutive patients who underwent FB-EVAR with distal landing at the infrarenal aorta were reviewed retrospectively. The primary outcome measured any type IB endoleak over time. Secondary outcomes measured perioperative complications of paraplegia and bowel ischemia, preservation of lumbar artery and IMA, and degeneration of infrarenal aorta (diameter of infrarenal aorta at landing zone) and common iliac arteries (maximum diameters) over time.RESULTS: Between August 2011 and August 2017, 40 patients (40% male with a mean age of 72 ± 8 years) affected by types I (37.5%), II (25.0%), III (20.0%), and V (17.5%) thoracoabdominal aneurysms were included. The mean aneurysm diameter was 6.4 ± 1.5 cm. There was no immediate or delayed type IB endoleak with mean follow-up period of 15 ± 18 months (range, 0-72 months). Postoperative complications included six (15%) spinal cord ischemia (five temporary and one permanent) and no mesenteric ischemia. There were three deaths (7.5%) within 30 days. Follow-up with computed tomography arteriography showed that 37 patients (92.5%) had at least one lumbar artery preserved. Out of the 31 preoperatively patent IMA, 23 (74.2%) were preserved. There was one incidental finding of new focal dissection distal to the stent graft end. Mean infrarenal aorta diameters were 24.8, 27.7, 27.7, and 29.4 mm immediately preoperatively, and at 1 and 2 years postoperatively, respectively. The mean maximal right common iliac diameters were stable and measured 15.8, 15.9, and 14.8 mm preoperatively, immediately postoperatively, and 1 year postoperatively, respectively. Mean maximal left common iliac diameters were also stable and measured 15.7, 15.9, and 14.7 mm preoperatively, immediately postoperatively, and at 1 year postoperatively, respectively.CONCLUSIONS: Our early experience showed that distal landing at the infrarenal aorta was secure in FB-EVAR with no type IB endoleak, although the observation of gradual infrarenal aortic degeneration mandates regular surveillance.",

keywords = "Aged, Aged, 80 and over, Aorta, Abdominal/diagnostic imaging, Aortic Aneurysm, Thoracic/diagnostic imaging, Aortography/methods, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation/adverse effects, Computed Tomography Angiography, Endovascular Procedures/adverse effects, Female, Humans, Male, Middle Aged, Postoperative Complications/etiology, Prosthesis Design, Retrospective Studies, Risk Factors, Stents, Time Factors, Treatment Outcome",

author = "Yuk Law and Tilo K{\"o}lbel and Fiona Rohlffs and Christian Behrendt and Franziska Heidemann and Debus, {Eike Sebastian} and Nikolaos Tsilimparis",

year = "2019",

month = feb,

doi = "10.1016/j.jvs.2018.04.052",

language = "English",

volume = "69",

pages = "334--340",

journal = "J VASC SURG",

issn = "0741-5214",

publisher = "Mosby Inc.",

number = "2",

}

RIS

TY - JOUR

T1 - Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm

AU - Law, Yuk

AU - Kölbel, Tilo

AU - Rohlffs, Fiona

AU - Behrendt, Christian

AU - Heidemann, Franziska

AU - Debus, Eike Sebastian

AU - Tsilimparis, Nikolaos

PY - 2019/2

Y1 - 2019/2

N2 - OBJECTIVE: Manufacturers often recommend the iliac arteries as the distal landing zone in fenestrated or branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aneurysm. It is not uncommon to choose distal landing at the infrarenal aorta for preservation of lumbar arteries or the inferior mesenteric artery (IMA); however, the safety and durability of this procedure have not been verified in the literature.METHODS: Consecutive patients who underwent FB-EVAR with distal landing at the infrarenal aorta were reviewed retrospectively. The primary outcome measured any type IB endoleak over time. Secondary outcomes measured perioperative complications of paraplegia and bowel ischemia, preservation of lumbar artery and IMA, and degeneration of infrarenal aorta (diameter of infrarenal aorta at landing zone) and common iliac arteries (maximum diameters) over time.RESULTS: Between August 2011 and August 2017, 40 patients (40% male with a mean age of 72 ± 8 years) affected by types I (37.5%), II (25.0%), III (20.0%), and V (17.5%) thoracoabdominal aneurysms were included. The mean aneurysm diameter was 6.4 ± 1.5 cm. There was no immediate or delayed type IB endoleak with mean follow-up period of 15 ± 18 months (range, 0-72 months). Postoperative complications included six (15%) spinal cord ischemia (five temporary and one permanent) and no mesenteric ischemia. There were three deaths (7.5%) within 30 days. Follow-up with computed tomography arteriography showed that 37 patients (92.5%) had at least one lumbar artery preserved. Out of the 31 preoperatively patent IMA, 23 (74.2%) were preserved. There was one incidental finding of new focal dissection distal to the stent graft end. Mean infrarenal aorta diameters were 24.8, 27.7, 27.7, and 29.4 mm immediately preoperatively, and at 1 and 2 years postoperatively, respectively. The mean maximal right common iliac diameters were stable and measured 15.8, 15.9, and 14.8 mm preoperatively, immediately postoperatively, and 1 year postoperatively, respectively. Mean maximal left common iliac diameters were also stable and measured 15.7, 15.9, and 14.7 mm preoperatively, immediately postoperatively, and at 1 year postoperatively, respectively.CONCLUSIONS: Our early experience showed that distal landing at the infrarenal aorta was secure in FB-EVAR with no type IB endoleak, although the observation of gradual infrarenal aortic degeneration mandates regular surveillance.

AB - OBJECTIVE: Manufacturers often recommend the iliac arteries as the distal landing zone in fenestrated or branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aneurysm. It is not uncommon to choose distal landing at the infrarenal aorta for preservation of lumbar arteries or the inferior mesenteric artery (IMA); however, the safety and durability of this procedure have not been verified in the literature.METHODS: Consecutive patients who underwent FB-EVAR with distal landing at the infrarenal aorta were reviewed retrospectively. The primary outcome measured any type IB endoleak over time. Secondary outcomes measured perioperative complications of paraplegia and bowel ischemia, preservation of lumbar artery and IMA, and degeneration of infrarenal aorta (diameter of infrarenal aorta at landing zone) and common iliac arteries (maximum diameters) over time.RESULTS: Between August 2011 and August 2017, 40 patients (40% male with a mean age of 72 ± 8 years) affected by types I (37.5%), II (25.0%), III (20.0%), and V (17.5%) thoracoabdominal aneurysms were included. The mean aneurysm diameter was 6.4 ± 1.5 cm. There was no immediate or delayed type IB endoleak with mean follow-up period of 15 ± 18 months (range, 0-72 months). Postoperative complications included six (15%) spinal cord ischemia (five temporary and one permanent) and no mesenteric ischemia. There were three deaths (7.5%) within 30 days. Follow-up with computed tomography arteriography showed that 37 patients (92.5%) had at least one lumbar artery preserved. Out of the 31 preoperatively patent IMA, 23 (74.2%) were preserved. There was one incidental finding of new focal dissection distal to the stent graft end. Mean infrarenal aorta diameters were 24.8, 27.7, 27.7, and 29.4 mm immediately preoperatively, and at 1 and 2 years postoperatively, respectively. The mean maximal right common iliac diameters were stable and measured 15.8, 15.9, and 14.8 mm preoperatively, immediately postoperatively, and 1 year postoperatively, respectively. Mean maximal left common iliac diameters were also stable and measured 15.7, 15.9, and 14.7 mm preoperatively, immediately postoperatively, and at 1 year postoperatively, respectively.CONCLUSIONS: Our early experience showed that distal landing at the infrarenal aorta was secure in FB-EVAR with no type IB endoleak, although the observation of gradual infrarenal aortic degeneration mandates regular surveillance.

KW - Aged

KW - Aged, 80 and over

KW - Aorta, Abdominal/diagnostic imaging

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Aortography/methods

KW - Blood Vessel Prosthesis

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Computed Tomography Angiography

KW - Endovascular Procedures/adverse effects

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Complications/etiology

KW - Prosthesis Design

KW - Retrospective Studies

KW - Risk Factors

KW - Stents

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.jvs.2018.04.052

DO - 10.1016/j.jvs.2018.04.052

M3 - SCORING: Journal article

C2 - 29945837

VL - 69

SP - 334

EP - 340

JO - J VASC SURG

JF - J VASC SURG

SN - 0741-5214

IS - 2

ER -