Mid-Term Results of Fenestrated/Branched Stent Grafting to Treat Post-dissection Thoraco-abdominal Aneurysms
| Autor: | Piotr M. Kasprzak, Karin Pfister, Kyriakos Oikonomou, Eric L.G. Verhoeven, Athanasios Katsargyris, Pablo Marques de Marino |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Endoleak Dissection (medical) 030204 cardiovascular system & hematology 030230 surgery Fenestrated Blood Vessel Prosthesis Implantation 03 medical and health sciences Aortic aneurysm Postoperative Complications 0302 clinical medicine Aneurysm Aneurysm Dissecting Risk Factors Chronic dissection medicine.artery Occlusion medicine Humans Hospital Mortality Superior mesenteric artery Renal artery Vascular Patency Aged Retrospective Studies Aortic dissection Aortic Aneurysm Thoracic business.industry Thoraco-abdominal aneurysm Middle Aged medicine.disease Branched Survival Analysis Thrombosis Surgery Aortic Dissection Female Stents Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | European Journal of Vascular and Endovascular Surgery. 57:102-109 |
| ISSN: | 1078-5884 |
| Popis: | OBJECTIVES: Patients surviving acute aortic dissection are at risk of developing a post-dissection thoraco-abdominal aortic aneurysm (PD-TAAA) during follow up, regardless of the type of treatment in the acute setting. Fenestrated and branched stent grafting (F/B-TEVAR) has been used with success to treat PD-TAAA, albeit reported only with short-term results. The aim of this study was to report mid-term results in a cohort of 71 patients. METHODS: This was a retrospective analysis of a prospectively maintained database including all patients with PD-TAAAs who underwent F/B-TEVAR within the period January 2010 - April 2017 at two vascular institutions experienced in endovascular techniques. RESULTS: A total of 71 consecutive patients (56 male, mean age 63.8 ± 10.6 years) were treated. Technical success was achieved in 68/71 (95.8%) patients. In hospital mortality was four (5.6%) patients. Peri-operative morbidity was 19.6%. Three (4.2%) patients developed severe spinal cord ischaemia, one of these patients 12 months post-operatively. Mean follow up was 25.3 months (1-77 months). Cumulative survival rates at 12, 24, and 36 months were 84.7 ± 4.5%, 80.7 ± 5.1%, and 70.0 ± 6.7%, respectively. Estimated freedom from re-intervention at 12, 24, and 36 months was 80.7 ± 5.3%, 63.0 ± 6.9%, and 52.6 ± 8.0%, respectively. The main reasons for re-intervention were endoleak from visceral/renal arteries and iliac endoleak requiring extension. Target vessel occlusion occurred in 8/261 (3.1%) vessels (renal artery n = 4; superior mesenteric artery n = 2; coeliac artery n = 2). Mean aneurysm sac regression during follow up was 9.2 ± 8.8 mm, with a false lumen thrombosis rate of 85.4% for patients with a follow up longer than 12 months. No ruptures occurred during follow up. CONCLUSION: F/B-TEVAR for post-dissection TAAA is feasible and associated with low peri-operative mortality and peri-operative morbidity. Mid-term results demonstrate a high rate of aneurysm sac regression. Rigorous follow up is required because of the significant re-intervention rate. Longer bridging covered stents for target vessels are advised. ispartof: Eur J Vasc Endovasc Surg vol:57 issue:1 pages:102-109 ispartof: location:England status: published |
| Databáze: | OpenAIRE |
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