Predictors of inadequate EndoAnchors aortic wall penetration for the Endosutured therapy in hostile neck patients.

Autor:	Reyes Valdivia A; Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain - cauzaza@hotmail.com., Duque Santos Á; Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain., Pitoulias G; Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.; Division of Vascular Surgery, Second Department of Surgery, G. Gennimatas Thessaloniki General Hospital, Thessaloniki, Greece., Aracil Sanus E; Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain., Ocaña Guaita J; Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain., Gandarias Zúñiga C; Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	The Journal of cardiovascular surgery [J Cardiovasc Surg (Torino)] 2020 Dec; Vol. 61 (6), pp. 738-744. Date of Electronic Publication: 2020 Jun 19.
DOI:	10.23736/S0021-9509.20.11248-5
Abstrakt:	Background: The use of EndoAnchors is increasing; however, not much about appropriate use in terms of aortic wall penetration (AWP) is described. We aim to evaluate the procedural and anatomical conditions related with borderline (b) or absence (ab) of AWP when checked on first CT-scan after the Endosutured aortic repair (ESAR) for hostile neck anatomies (HNA). Methods: This study with NCT04100499 is a single center prospective evaluation of patients receiving EndoAnchors for prevention or treatment of a proximal EVAR failure. AWP was evaluated on first CT-scan and findings correlated with neck anatomical features and procedural data. The sum of borderline and absence of AWP was considered as Inadequate - In-AWP (failure). Adjunctive procedures, reinterventions, all-cause mortality, absence of type Ia EL and aneurysm related mortality are also described. Results: Forty-eight patients were treated during the study period and 43 high-surgical risk patients were finally included in the study for analysis with at least one HNA criteria (58%) and associating two in 21% or even three in 21%. A total of 250 EndoAnchors were deployed at a median 6 (range, 4-10) per case. From those, 31 (12.5%) achieved b-AWP and 11 (4.4%) ab-AWP, meaning 42 (16.8%) EndoAnchors with In-AWP. Univariate-analysis showed being an occasional user and a therapeutic case as predictor for at least one and more failures. The only predictor on multivariate analysis for two or more EndoAnchors with In-AWP was being an occasional user. Cumulative-survival and freedom from type-Ia EL at 2-years was 84% and 95%; respectively. Conclusions: Outcomes of the ESAR therapy should be validated according to their aortic wall penetration checked on first CT-scan. EndoAnchors use in HNA should not be considered an easy approach for the endovascular technique, especially for therapeutic cases. An individual and specific case analysis counterbalancing inadequate use of the device in unexperienced users should be evaluated against the increased risk of proximal failure as in standard EVAR alone during HNA treatment.
Databáze:	MEDLINE
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