Initial Clinical Experience With a New Conformable Abdominal Aortic Endograft: Aortic Neck Coverage and Curvature Analysis in Challenging Aortic Necks

Abstract

Objectives:

Aim of this work was to investigate precision of deployment and conformability of a new generation GORE EXCLUDER Conformable Endoprosthesis with active control system (CEXC Device, W.L. Gore and Associates, Flagstaff, AZ, USA) by analyzing aortic neck coverage and curvature.

Methods:

All consecutive elective patients affected by abdominal aortic aneurysm or aortoiliac aneurysm treated at our institution between November 2018 and June 2019 with the new CEXC Device were enrolled. Validated software was adopted to determine the available apposition surface area into the aortic neck, apposition of the endograft to the aortic wall, shortest apposition length (SAL), shortest distance between the endograft fabric and the lowest renal arteries (SFD) and between the endograft fabric and the contralateral renal artery (CFD). Pointwise centerline curvature was also computed.

Results:

Twelve patients (10 men, median age 78 years (71.75, 81.0)) with available pre- and postoperative computed tomography angiography (CTA) were included. Technical success was obtained in all the cases. Preoperative median length of the proximal aortic neck was 16.1 mm (10.7, 21.7) and suprarenal (α) and infrarenal (β) neck angulation were, respectively, 28.9° (15.7°, 47.5°) and 75.0° (66.9°, 81.4°). Postoperative median apposition surface coverage was 79% (69.25%, 90.75%) of the available apposition surface. SFD and CFD were 1.5 mm (0.75, 5.25) and 7 mm (4.5, 21.5), respectively. Average curvature over the infrarenal aorta decreased from 25 m⁻¹ (21.75, 29.0) to 22.5 m⁻¹ (18.75, 24.5) postoperatively (p=0.02). Maximum curvature did not decrease significantly from 64.5 m⁻¹ (54.25, 92.0) to 62 m⁻¹ (41.75, 71.5) (p=0.1).

Conclusions:

Our early experience showed that deployment of the CEXC Device is safe and effective for patients with challenging proximal aortic necks. Absence of significant changes between pre- and postoperative proximal aortic neck angulations and curvature confirms the high conformability of this endograft.

Keywords

abdominal aortic aneurysm apposition endovascular treatment geometric analysis sealing

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References

Greenhalgh

Brown

Powell

, et al. Endovascular versus open repair of abdominal aortic aneurism. N Engl J Med. 2010;362:1863–1871.

Wanhainen

Verzini

Van Herzeele

, et al. Editor’s choice. European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019;57:8–93.

Rhee

Peterson

Moore

, et al. Initial human experience with the GORE EXCLUDER conformable AAA endoprosthesis. J Vasc Surg Cases Innov Tech. 2019;5:319–322.

Van Noort

Schuurmann

Slump

, et al. A new method for precise determination of endograft position and apposition in the aortic neck after endovascular aortic aneurysm repair. J Vasc Surg. 2016;57:737–746.

Schuurmann

RCL

Overeem

Van Noort

, et al. Validation of a new methodology to determine 3-dimensional endograft apposition, position, and expansion in the aortic neck after endovascular aneurysm repair. J Endovasc Ther. 2018;25:358–365.

Schuurmann

RCL

Kuster

Slump

, et al. Aortic curvature instead of angulation allows improved estimation of the true aorto-iliac trajectory. Eur J Vasc Endovasc Surg. 2016;51:216–224.

Schuurmann

RCL

Ouriel

Muhs

, et al. Aortic curvature as a predictor of intraoperative type Ia endoleak. J Vasc Surg. 2016;63:596–602.

Schuurmann

Van Noort

Overeem

, et al. Aortic curvature is a predictor of late type Ia endoleak and migration after endovascular aneurysm repair. J Endovasc Ther. 2017;24:411–417.

Ishibashi

Ishiguchi

Ohta

, et al. Remodeling of proximal neck angulation after endovascular aneurysm repair. J Vasc Surg. 2012;56:1201–1205.

10.

Gonçalves

Hoeks

Teijink

, et al. Risk factors for proximal neck complications after endovascular aneurysm repair using the Endurant stent-graft. Eur J Vasc Endovasc Surg. 2015;49:156–162.

11.

Marone

Freyrie

Ruotolo

, et al. Expert opinion on hostile neck definition in endovascular treatment of abdominal aortic aneurysm (a Delphi consensus). Ann Vasc Surg. 2020;62:173–182.

12.

Schuurmann

van Noort

Overeem

, et al. Determination of endograft apposition, position, and expansion in the aortic neck predicts type Ia endoleak and migration after endovascular aneurysm repair. J Endovasc Ther. 2018;25:366–375.

13.

Chen

Hsu

Chen

, et al. The impact of aortic tortuosity on delayed type I or III endoleak after endovascular aortic repair. Ann Vasc Surg. 2017;41:110–117.

14.

Schuurmann

De Rooy

Bastos Gonçalves

, et al. A systematic review of standardized methods for assessment of endograft sealing on computed tomography angiography post-endovascular aortic repair, and its influence on endograft-associated complications. Expert Rev Med Devices. 2019;16:683–695.

15.

Teijink

Power

Böckler

, et al. Five year outcomes of the Endurant stent graft for endovascular abdominal aortic aneurysm repair in the ENGAGE registry. Eur J Vasc Endovasc Surg. 2019;58:175–181.

16.

Schuurmann

Overeem

Ouriel

, et al. A semiautomated method for measuring the 3-dimensional fabric to renal artery distances to determine endograft position after endovascular aneurysm repair. J Endovasc Ther. 2017;24:698–706.

17.

Schneider

Milner

Heyligers

, et al. Outcomes of the GORE Iliac Branch Endoprosthesis in clinical trial and real-world registry settings. J Vasc Surg. 2019;69:367–377.

18.

Karch

Hodgson

Mattos

, et al. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2000;32:676–683.

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