Outcomes of a novel upper extremity preloaded delivery system for fenestrated-branched endovascular repair of thoracoabdominal aneurysms
| Autor: | Gustavo S. Oderich, Keouna Pather, Jussi M. Kärkkäinen, Bernardo C. Mendes, Jarin Kratzberg, Emanuel R. Tenorio, Randall R. DeMartino, Aleem K. Mirza |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Brachial Artery Non-Randomized Controlled Trials as Topic medicine.medical_treatment Operative Time Punctures 030204 cardiovascular system & hematology Prosthesis Design Thoracoabdominal Aortic Aneurysms Blood Vessel Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Aneurysm Catheterization Peripheral Operating time Humans Medicine Fluoroscopy Prospective Studies 030212 general & internal medicine Adverse effect Aged Aged 80 and over Aortic Aneurysm Thoracic medicine.diagnostic_test business.industry Endovascular Procedures Stent Middle Aged medicine.disease Blood Vessel Prosthesis Surgery Femoral Artery Treatment Outcome Feasibility Studies Operative time Female Stents Delivery system Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Vascular Surgery. 72:470-479 |
| ISSN: | 0741-5214 |
| Popis: | Objective The aim of this study was to evaluate the feasibility and outcomes of endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) using a novel low profile (LP) device with upper extremity preloaded guidewire system (PGS) and compare procedural metrics and outcomes with a standard multibranch stent graft (t-Branch; Cook Medical, Bloomington, Ind). Methods We reviewed the clinical data of 232 consecutive patients treated by fenestrated-branched endovascular aortic repair for TAAA and enrolled in a prospective nonrandomized trial between 2014 and 2017. Patients who had repair using t-Branch or patient-specific TAAA devices using upper extremity LP-PGS were included. End points were technical success, operative and fluoroscopic time, patient radiation exposure, time from arterial access to complete device deployment, total contrast volume, and 30-day rates of major adverse events (MAEs) and mortality. Results There were 54 patients, including 33 males (67%) and 21 females (33%), with a mean age of 73 ± 9 years old. Forty-nine patients (91%) had extent I-III and five patients (9%) had extent IV TAAAs. Device design was t-Branch in 24 patients (44%) and LP-PGS in 30 patients (56%). A total of 206 renal-mesenteric arteries were incorporated with no difference between groups (mean, 3.8 ± 0.6 target vessels/patient; P = .92). Patients treated by t-Branch device had larger mean aneurysm diameter (79 ± 16 vs 66 ± 10 mm; P = .0006). All patients had transbrachial approach. Technical success was achieved in all patients in both groups. Patients treated by LP-PGS devices had lower radiation dose (1250 ± 849 vs 3154 ± 2421 mGy; P = .003) and shorter operating time for complete device deployment (105 ± 42 vs 123 ± 34 minutes; P = .043). There was no difference in mean operative time (252 ± 69 vs 273 ± 56 minutes; P = .23), fluoroscopy time (82 ± 29 vs 96 ± 35 minutes; P = .08) or contrast volume (163 ± 59 vs 197 ± 75 mL; P = .07) comparing LP-PGS and t-Branch respectively. There was no 30-day or in-hospital mortality. There were no differences in MAEs, which occurred in 18 patients (33%) in both groups (P > .05). Conclusions Endovascular TAAA repair using the standard or LP-PGS multibranch stent graft was associated with high technical success, no mortality, and a low rate of MAEs in this study. Patients treated by upper extremity LP-PGS had shorter time to complete device deployment, suggesting decreased technical demand with preloaded systems. |
| Databáze: | OpenAIRE |
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