Fenestrated-branched endovascular repair for distal thoracoabdominal aortic pathology after total aortic arch replacement with frozen elephant trunk.

Autor:	Shalan A; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Tenorio ER; Division of Vascular Surgery, Mayo Clinic, Rochester, MN; University of Texas Health Sciences Centre at Houston, McGovern Medical School, Houston, TX., Mascaro JG; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Juszczak MT; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Claridge MW; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Melloni A; Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Bertoglio L; Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Chiesa R; Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Oderich GS; Division of Vascular Surgery, Mayo Clinic, Rochester, MN; University of Texas Health Sciences Centre at Houston, McGovern Medical School, Houston, TX., Adam DJ; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Electronic address: donald.adam@uhb.nhs.uk.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2022 Oct; Vol. 76 (4), pp. 867-874. Date of Electronic Publication: 2022 Jun 10.
DOI:	10.1016/j.jvs.2022.04.035
Abstrakt:	Objective: To report the outcomes of fenestrated-branched endovascular repair (FBEVAR) for thoracoabdominal aortic pathology after total aortic arch replacement with frozen elephant trunk (TAR+FET). Methods: Interrogation of prospectively maintained databases from four high-volume aortic centers identified consecutive patients treated with distal FBEVAR after prior TAR+FET between August 2013 and September 2020. The primary end point was 30-day/in-hospital mortality. Secondary end points were technical success, early clinical success, midterm survival, and freedom from reintervention. Data are presented as median (interquartile range). Results: A total of 39 patients (21 men; median age, 73 years [67-75 years]) with degenerative (n = 22) and postdissection thoracoabdominal aortic aneurysms (n = 17) (median diameter, 71 mm [61-78 mm]) were identified. Distal FBEVAR was intended in 27 patients (median interval, 9.8 months [6.2-16.6 months]), anticipated in 7, and unexpected in 5. A total of 31 patients had a two- (n = 24) or three-stage (n = 7) distal FBEVAR. Renovisceral target vessel preservation was 99.3% (145 of 146). Early primary and secondary technical success was 92% and 97%, respectively. Thirty-day mortality was 2.6% (n = 1; respiratory failure and spinal cord ischemia [SCI]). Six survivors also developed SCI, which was associated with complete (n = 4) or partial recovery (n = 2) at hospital discharge. No patients required renal replacement therapy or suffered a stroke. Early clinical success was 95%. Median follow-up was 30.5 months (23.7-49.7 months). Eleven patients required 16 late reinterventions. Estimated 3-year survival and freedom from reintervention were 84% ± 6% and 63% ± 10%, respectively. Conclusions: Distal FBEVAR after prior TAR+FET is associated with high technical success and low early mortality. The risk of SCI is significant although the majority of patients demonstrate full or partial recovery before hospital discharge. Midterm patient survival is favorable, but there remains a high requirement for late reintervention. FBEVAR represents an acceptable alternative to distal open thoracoabdominal aortic aneurysm repair. (Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu