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Preliminary results from a multicenter Italian registry on the use of a new branched device for the treatment of thoracoabdominal aortic aneurysms.

Authors
  • Angiletta, Domenico1
  • Piffaretti, Gabriele2
  • Patruno, Isabella1
  • Wiesel, Paola1
  • Zacà, Sergio1
  • Perkmann, Rainhold3
  • Antonello, Michele4
  • Bush, Ruth L5
  • Pulli, Raffaele6
  • 1 Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. , (Italy)
  • 2 Vascular Surgery- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy. , (Italy)
  • 3 Vascular and Thoracic Surgery, Bolzano Hospital, Bolzano, Italy. , (Italy)
  • 4 Vascular Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy. , (Italy)
  • 5 University of Houston College of Medicine, Houston, Tex.
  • 6 Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. Electronic address: [email protected] , (Italy)
Type
Published Article
Journal
Journal of vascular surgery
Publication Date
Aug 01, 2021
Volume
74
Issue
2
Pages
404–413
Identifiers
DOI: 10.1016/j.jvs.2020.12.092
PMID: 33548421
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The study purpose was to present early outcomes of patients treated for thoracoabdominal aortic aneurysms or complex abdominal aortic diseases using endovascular repair with a new branched endograft. This multicenter, retrospective, observational cohort study included all patients treated with a new branched endograft. All elective patients were treated with a staged operative strategy and spinal drainage Primary outcomes of interest were technical success, early (≤30 days) mortality, and late (≥30 days) survival, and freedom from adverse aortic events. A total of 16 consecutive patients were treated for Crawford's extent type I (n = 1), type II (n = 7), type III (n = 1), and type IV (n = 5) endoleaks, with an additional two complex pararenal abdominal aortic lesions (enlarging type Ia endoleak, n = 1; anastomotic pseudoaneurysm, n = 1). There were 13 male (81%) and 3 female (19%) patients with a median age of 72.5 years (interquartile range [IQR], 69-78 years). The median diameter of the aortic aneurysm was 65 mm (IQR, 58-81 mm) and the median EuroSCORE prediction for mortality was 18% (IQR, 12%-36%). Thoracoabdominal aortic aneurysm was secondary to a previous dissection in four patients. A total of 62 of the 64 visceral vessels (96.9%) were stented. Technical success was achieved in 14 (87.5 %) and the cumulative aorta-related mortality rate was 19%. Spinal cord ischemia did not occur. The mean follow-up was 8 ± 4 months (range, 2-15 months). No type I or type III endoleaks were detected. Primary bridging stent patency was 98% (one asymptomatic thrombotic occlusion of a celiac trunk branch). No aortic reintervention was required. Endovascular repair of complex aortic aneurysms with this new branched endograft can be performed with high technical success and acceptable morbidity. A 19% mortality is quite high; however, it is tolerable in such a high-risk cohort. The survival rate was acceptable, and graft-related outcomes at early follow-up included an absence of threatening endoleaks and a high target visceral vessel patency. Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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