Early results with the custom-made Fenestrated Anaconda aortic cuff in the treatment of complex abdominal aortic aneurysm

Autor: Spyridon N. Mylonas, Piotr M. Kasprzak, G.F. Fadda, Karin Pfister, G. Rouhani, R. Meerwaldt, Drosos Kotelis, R. Martinez, M. Delbridge, Robert H. Geelkerken, C.J. Zeebregts, Arne de Niet, Jan-Willem H. P. Lardenoije, M.M.P.J. Reijnen, Hence J.M. Verhagen, R. Williams, Clark J. Zeebregts, A. Papaioannou, J. Falkensammer, Bartosz Rylski, Jan Brunkwall, A. Giménez-Gaibar, Michel M.P.J. Reijnen, I. F. J. Tielliu, A. de Niet
Přispěvatelé: Multi-Modality Medical Imaging, Man, Biomaterials and Microbes (MBM), Surgery
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Time Factors
Computed Tomography Angiography
DURABILITY
030204 cardiovascular system & hematology
Kidney
0302 clinical medicine
Interquartile range
Risk Factors
EVAR
030212 general & internal medicine
Superior mesenteric artery
ENDOGRAFT
COMPLICATIONS
OUTCOMES
biology
Endovascular Procedures
Abdominal aortic aneurysm
Progression-Free Survival
Europe
Treatment Outcome
Cuff
cardiovascular system
Female
Stents
Cardiology and Cardiovascular Medicine
Glomerular Filtration Rate
medicine.medical_specialty
MIGRATION
Perforation (oil well)
Prosthesis Design
Aortography
Anaconda
03 medical and health sciences
Blood Vessel Prosthesis Implantation
Aneurysm
medicine.artery
medicine
Humans
Renal artery
Vascular Patency
Aged
Retrospective Studies
Fenestrated Anaconda aortic cuff
business.industry
ENDOVASCULAR REPAIR
biology.organism_classification
medicine.disease
n/a OA procedure
ENDOLEAK
Surgery
Blood Vessel Prosthesis
Feasibility Studies
EXPERIENCE
STENT-GRAFTS
business
Aortic Aneurysm
Abdominal
Zdroj: Journal of vascular surgery, 69(2), 348-356. Elsevier
Journal of Vascular Surgery, 69(2), 348-356. MOSBY-ELSEVIER
Journal of Vascular Surgery, 69(2), 348-356. Mosby Inc.
ISSN: 0741-5214
Popis: Objective: The objective of this study was to investigate the feasibility of a specific custom-made fenestrated aortic cuff in the treatment of complex abdominal aortic aneurysms (AAAs).Methods: Between 2013 and 2016, a total of 57 custom-made Fenestrated Anaconda (Vascutek, Inchinnan, Scotland, UK) aortic cuffs were placed in 38 centers worldwide. All centers were invited to participate in this retrospective analysis. Postoperative and follow-up data included the presence of adverse events, necessity for reintervention, and renal function.Results: Fifteen clinics participated, leading to 29 cases. Median age at operation was 74 years (interquartile range [IQR], 71-78 years); five patients were female. Two patients were treated for a para-anastomotic AAA after open AAA repair, 19 patients were treated because of a complicated course after primary endovascular AAA repair, and 8 cases were primary procedures for AAA. A total of 76 fenestrations (mean, 2.6 per case) were used. Four patients needed seven adjunctive procedures. Two patients underwent conversion, one because of a dissection of the superior mesenteric artery and one because of perforation of a renal artery. Median operation time was 225 minutes (IQR, 150-260 minutes); median blood loss, 200 mL (IQR, 100-500 mL); and median contrast volume, 150 mL (IQR, 92-260 mL). Primary technical success was achieved in 86% and secondary technical success in 93%. The 30-day morbidity was 7 of 29 with amortality rate of 4 of 29. Estimated glomerular filtration rate remained unchanged before and after surgery (76 to 77 mL/min/m(2)). Between preoperative and median follow-up of 11 months, estimated glomerular filtration rate was reduced statistically significantly (76 to 63 mL/min/m(2)). During follow-up, 9 cases had an increase in aneurysm sac diameter (5 cases > 5 mm); 14 cases had a stable or decreased aneurysm sac diameter; and in 2 cases, no aneurysm size was reported. No type I endoleak was reported, and two cases with a type III endoleak were treated by endovascular means during follow-up. Survival, reintervention-free survival, and target vessel patency at 1 year were 81% +/- 8%, 75% +/- 9%, and 99% +/- 1%, respectively. After 2 years, these numbers were 81% +/- 8%, 67% +/- 11%, and 88% +/- 6%, respectively. During follow-up, the two patients with a type III endoleak needed endograft-related reinterventions.Conclusions: Treatment with this specific custom-made fenestrated aortic cuff is feasible after complicated previous (endovascular) aortic repair or in complex AAAs. The complexity of certain AAA cases is underlined in this study, and the Fenestrated Anaconda aortic cuff is a valid option in selected cases in which few treatment options are left.
Databáze: OpenAIRE
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