Correlations Between Branch Vessel Catheterization and Procedural Complexity in Fenestrated and Branched Endovascular Aneurysm Repair

Abstract

Introduction:

The use of fenestrated and branched endovascular technologies in complex aortic aneurysm repair (F/BEVAR) is increasing, with a trend toward using longer sealing zones and incorporating more target vessels. Successful aneurysm exclusion and prevention of long-term treatment failure need to be balanced against the increased complexity of more extensive procedures. The aim of this study was to analyze relationships between the number of catheterized vessels and multiple operative variables as a means for evaluating procedural complexity.

Methods:

Operative data from consecutive F/BEVAR procedures performed at a single center from 2012 to 2015 were analyzed. An equal number of EVAR procedures, randomly selected, from this period were also analyzed. Only intact aneurysms were included. Complex aneurysms were grouped based on the required number of target vessel catheterization. Ten procedural variables, categorized as perioperative, postoperative, and radiologic-related, were compared. Pearson correlation analysis and regression analysis were performed. The correlation coefficients, r, were classified using Cohen boundaries, r ≥ 0.5 indicating a strong relationship.

Results:

There were 63 EVAR, 40 FEVAR, and 22 BEVAR procedures. There was no significant difference in patient comorbidities between conventional EVAR and complex procedure groups. The complex procedures included 23 two-vessel, 20 three-vessel, and 19 four-vessel catheterizations. Strong linear relationships between the number of branch vessel catheterizations and the following variables were identified: accumulated skin dose (r = .504), contrast volume (r = .652), fluoroscopy duration (r = .598), number of angiography series (r = .650), anesthesiology duration (r = .742), procedure duration (r = .554), and total length of stay (r = .533).

Conclusion:

The complexity of FEVAR and BEVAR procedures reveals strong correlations between multiple peri- and postoperative variables. These exposures and risks should be borne in mind when considering treatment of complex abdominal aortic aneurysms as well as long-term clinical outcomes.

Keywords

endovascular aneurysm repair FEVAR BEVAR catheterization radiation exposure abdominal aortic aneurysm

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References

Budtz-Lilly

Venermo

Debus

. Editor’s choice—assessment of international outcomes of intact abdominal aortic aneurysm repair over 9 years. Eur J Vasc Endovasc Surg. 2017;54(1):13–20. doi:10.1016/j.ejvs.2017.03.003

Beck

Sedrakyan

Mao

. International Consortium of Vascular Registries. Variations in Abdominal aortic aneurysm care: a report from the international consortium of vascular registries. Circulation. 2016;134(24):1948–1958.

Nordon

Hinchliffe

Holt

Loftus

Thompson

. Modern treatment of juxtarenal abdominal aortic aneurysms with fenestrated endografting and open repair—a systematic review. Eur J Vasc Endovasc Surg. 2009;38(1):35–41. doi:10.1016/j.ejvs.2009.02.012

Verhoeven

Tielliu

Bos

Zeebregts

. Present and future of branched stent grafts in thoraco-abdominal aortic aneurysm repair: a single-centre experience. Eur J Vasc Endovasc Surg. 2009;38(2):155–161. doi:10.1016/j.ejvs.2009.05.002

Budtz-Lilly

Wanhainen

Eriksson

Mani

. Adapting to a total endovascular approach for complex aortic aneurysm repair: outcomes after fenestrated and branched endovascular aortic repair. J Vasc Surg. 2017;66(5):1349–1356. doi:10.1016/j.jvs.2017.03.422

Greenberg

Roselli

. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair a comparison of endovascular and open techniques. Circulation. 2008;118(8):808–817. doi:10.1161/CIRCULATIONAHA.108.769695

Simons

Shue

Flahive

. Trends in use of the only Food and Drug Administration-approved commercially available fenestrated endovascular aneurysm repair device in the United States. J Vasc Surg. 2017;65(5):1260–1269. doi:10.1016/j.jvs.2016.10.101

El-Sayed

Patel

Cho

. Guy’s and St Thomas’ Cardiovascular Research collaborative. Radiation-induced DNA damage in operators performing endovascular aortic repair. Circulation. 2017;136(25):2406–2416. doi:10.1161/CIRCULATIONAHA.117.029550

Patel

Gallacher

Dourado

. Occupational radiation exposure during endovascular aortic procedures. Eur J Vasc Endovasc Surg. 2013;46(4):424–430. doi:10.1016/j.ejvs.2013.05.023

10.

de Ruiter

QMB

Reitsma

Moll

van Herwaarden

. Meta-analysis of cumulative radiation duration and dose during EVAR using mobile, fixed, or Fixed/3D Fusion C-Arms. J Endovasc Ther. 2016;23(6):944–956. doi:10.1177/1526602816668305

11.

Kirkwood

Arbique

Guild

Timaran

Valentine

Anderson

. Radiation-induced skin injury after complex endovascular procedures. J Vasc Surg. 2014;60(3):742–747. doi:10.1016/j.jvs.2014.03.236

12.

Kirkwood

Guild

Arbique

Anderson

Valentine

Timaran

. Surgeon radiation dose during complex endovascular procedures. J Vasc Surg. 2015;62(2):457–463. doi:10.1016/j.jvs.2015.02.050

13.

Cross

Gurusamy

Gadhvi

. Fenestrated endovascular aneurysm repair. Br J Surg. 2012;99(2):152–159. doi:10.1002/bjs.7804

14.

Anderson

Berce

Hartley

. Endoluminal aortic grafting with renal and superior mesenteric artery incorporation by graft fenestration. J Endovasc Ther. 2001;8(1):3–15. doi:10.1583/1545-1550(2001)008<0003: EAGWRA>2.0.CO;2

15.

Chuter

. Fenestrated and branched stent-grafts for thoracoabdominal, pararenal and juxtarenal aortic aneurysm repair. Semin Vasc Surg. 2007;20(2):90–96. doi:10.1053/j.semvascsurg.2007.04.006

16.

Crawford

Safi

. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986;3(3):389–404. doi:10.1016/0741-5214(86)90101 -1

17.

Fillinger

Greenberg

McKinsey

Chaikof

; Society for Vascular Surgery Ad Hoc Committee on TEVAR Reporting Standards. Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg. 2010;52(4):1022–1033.e15–1033. doi:10.1016/j.jvs.2010.07.008

18.

Reeves

Mahmud

. The evidence supporting radiation safety methods-working towards zero operator exposure. Imaging Med. 2016;8:3–12.

19.

Hertault

Maurel

Midulla

. Editor’s choice—minimizing radiation exposure during endovascular procedures: basic knowledge, literature review, and reporting standards. Eur J Vasc Endovasc Surg. 2015;50(1):21–36. doi:10.1016/j.ejvs.2015.01.014

20.

Maurel

Hertault

Sobocinski

. Techniques to reduce radiation and contrast volume during EVAR. J Cardiovasc Surg. 2014;55(2 Suppl 1):123–131.

21.

Howells

Eaton

Patel

. Risk of radiation exposure during endovascular aortic repair. Eur J Vasc Endovasc Surg. 2012;43(1):393–397. doi:10.1016/J.EJVS.2011.12.031

22.

Kalef-Ezra

Karavasilis

Ziogas

Dristiliaris

Michalis

Matsagas

. Radiation burden of patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2009;49(2):283–287. doi:10.1016/J.JVS.2008.09.003

23.

Maurel

Sobocinski

Perini

. Evaluation of radiation during EVAR Performed on a Mobile C-arm. Eur J Vasc Endovasc Surg. 2012;43(1):16–21. doi:10.1016/J.EJVS.2011.09.017

24.

Bai

. Fenestrated and chimney technique for juxtarenal aortic aneurysm: a systematic review and pooled data analysis. Sci Rep. 2016;6:20497. doi:10.1038/srep20497

25.

Katsargyris

Oikonomou

Kouvelos

Mufty

Ritter

Verhoeven

ELG

. Comparison of outcomes for double fenestrated endovascular aneurysm repair versus triple or quadruple fenestrated endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysms. J Vasc Surg. 2017;66(1):29–36. doi:10.1016/j.jvs.2016.11.043

26.

Fossaceca

Brambilla

Guzzardi

. The impact of radiological equipment on patient radiation exposure during endovascular aortic aneurysm repair. Eur Radiol. 2012;22(11):2424–2431. doi:10.1007/s00330-012-2492-4

27.

Hertault

Maurel

Sobocinski

. Impact of hybrid rooms with image fusion on radiation exposure during endovascular aortic repair. Eur J Vasc Endovasc Surg. 2014;48(4):382–390. doi:10.1016/j.ejvs.2014.05.026

28.

Bisdas

Donas

Torsello

Austermann

. Technical assessment of the preloaded fenestrated stent-graft in the management of pararenal aortic aneurysms. J Endovasc Ther. 2013;20(4):461–468.