Fenestrated/Branched Endovascular Aortic Aneurysm Repair Using a Supraceliac Aortic Proximal Seal Zone Versus an Infraceliac Aortic Proximal Seal Zone
| Autor: | Edward J. Arous, Allison Wyman, Shernaz S. Dossabhoy, Sourav Podder, Dejah R. Judelson, Andres Schanzer, Francesco A. Aiello, Jessica P. Simons |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Databases Factual Endoleak medicine.medical_treatment Investigational device exemption 030204 cardiovascular system & hematology 030230 surgery Prosthesis Design Endovascular aneurysm repair Seal (mechanical) 03 medical and health sciences Aortic aneurysm Blood Vessel Prosthesis Implantation 0302 clinical medicine Aneurysm Blood vessel prosthesis Celiac artery Celiac Artery Risk Factors medicine.artery medicine Humans Vascular Patency Aged Retrospective Studies Aged 80 and over business.industry Endovascular Procedures General Medicine medicine.disease Progression-Free Survival Surgery Blood Vessel Prosthesis Massachusetts Retreatment Female Cardiology and Cardiovascular Medicine business Abdominal surgery Aortic Aneurysm Abdominal |
| Zdroj: | Annals of vascular surgery. 62 |
| ISSN: | 1615-5947 |
| Popis: | Fenestrated/branched endovascular aneurysm repair (F/B-EVAR) achieves more extensive proximal seal than conventional infrarenal devices, thereby increasing aneurysm exclusion durability. Optimal seal zone length remains undefined. We assessed relative risks and benefits of extending the proximal seal above the celiac artery.The prospective database of all complex endovascular aortic aneurysm repairs at a single institution (institutional review board-approved, physician-sponsored investigational device exemption trial, 10/2010-6/2017) was used to classify repairs according to the number of target visceral-renal arteries incorporated: 4-vessel versus4-vessel. Comparisons of aneurysm characteristics, perioperative details, and postoperative complications were performed, stratified by repair type. One-year survival, target artery patency, freedom from type 1 or 3 endoleak, and freedom from reintervention were estimated with Kaplan-Meier analysis.Among 175 F/B-EVARs, 38% (n = 67) were 4-vessel and 62% (n = 108) were4-vessel. Intraoperatively, there was no difference in mean contrast use (76 mL vs. 74 mL, P = non significant [NS]) or dose area product (63,428 mGy cmWith F/B-EVAR, utilization of a supraceliac seal zone, compared with an infraceliac seal zone, is associated with statistical differences in operative characteristics/resource utilization, but with negligible clinical significance. Further innovation to eliminate type 3 endoleaks at fenestrations/branches remains an unmet need. To achieve adequate F/B-EVAR proximal seal zone length, one should have a low threshold to incorporate the celiac artery. |
| Databáze: | OpenAIRE |
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