Effects of preoperative visceral artery stenosis on target artery outcomes after fenestrated/branched endovascular aortic aneurysm repair
| Autor: | Carla K. Scott, Fatemeh Malekpour, Carlos H. Timaran, David E. Timaran, Marilisa Soto-Gonzalez, Melissa L. Kirkwood |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Visceral artery Time Factors Databases Factual Constriction Pathologic 030204 cardiovascular system & hematology 03 medical and health sciences Blood Vessel Prosthesis Implantation 0302 clinical medicine Postoperative Complications Interquartile range Celiac artery Celiac Artery Mesenteric Artery Superior Risk Factors medicine.artery Mesenteric Vascular Occlusion medicine Humans 030212 general & internal medicine Superior mesenteric artery Registries Splanchnic Circulation Vascular Patency Computed tomography angiography Aged Retrospective Studies medicine.diagnostic_test Aortic Aneurysm Thoracic business.industry Endovascular Procedures medicine.disease SMA Surgery Blood Vessel Prosthesis Stenosis medicine.anatomical_structure Treatment Outcome Female Stents Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Journal of vascular surgery. 73(5) |
| ISSN: | 1097-6809 |
| Popis: | Target artery stenosis might affect the outcomes of fenestrated/branched endovascular aortic aneurysm repair (F-BEVAR). The aim of the present study was to assess the effects of preoperative stenosis of the celiac artery (CA) and superior mesenteric artery (SMA) on the target artery outcomes after F-BEVAR.During a 4-year period, 287 consecutive patients, 204 men (71%) and 83 women (29%), had undergone F-BEVAR using fenestrated (83%), fenestrated-branched (4.5%), branched (3.5%), and off-the-shelf t-Branch (9%) devices (Cook Medical Inc, Bloomington, Ind). Preoperative SMA and CA significant stenosis was defined as a computed tomography angiography-based intraluminal diameter reduction50%. The primary endpoints included primary patency, freedom from target vessel instability, and patient survival.The median patient age was 71 years (interquartile range, 67-77 years). Suprarenal (36%), juxtarenal (25%), and thoracoabdominal (39%) aortic aneurysms were treated. The technical success rate was 99%. The 30-day survival was 97%. Among 981 stented vessels, 179 (18%) were CAs and 270 (27.5%) were SMAs. Significant preoperative CA stenosis was identified in 39 patients (22%) and SMA stenosis in 24 (9%). The median follow-up was 29.9 months. The primary patency rates at 12, 36, and 60 months were 98%, 92%, and 92% for the CA and 99%, 98%, and 98% for the SMA, respectively. Primary patency was significantly lower in the patients with previous significant CA stenosis than in those without stenosis (83%, 83%, and 76% vs 100%, 100%, and 97% at 12, 36, and 60 months, respectively; P .01). Freedom from celiac branch instability was also significantly lower among patients with significant stenosis (84%, 84%, and 76% vs 100%, 93%, and 93% at 12, 36, and 60 months; P .01). The presence of significant SMA stenosis did not affect either primary patency or freedom from target vessel instability. The survival rates at 12, 36, and 60 months were significantly lower for the patients with CA stenosis than for those without stenosis (67%, 61%, and 55% vs 90%, 84%, and 82%, respectively; P .01). Similarly, lower survival rates were observed for patients with significant SMA stenosis (70%, 60%, and 60% vs 87%, 79%, and 78% at 12, 36, and 60 months, respectively; P = .04).F-BEVAR was associated with overall primary patency rates90% for the CA and SMA. Preoperative CA stenosis was associated with lower primary patency and freedom from target vessel instability. In contrast, neither SMA branch primary patency nor freedom from target vessel instability were affected by preoperative SMA stenosis. We found visceral artery stenosis was a marker of atherosclerosis burden associated with reduced mid- and long-term patient survival. |
| Databáze: | OpenAIRE |
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