Outcomes after endovascular repair of abdominal aortic aneurysm involving the renovisceral arteries: A multi-center follow-up study

Abstract

Objectives

To evaluate outcomes after endovascular treatment of abdominal aortic aneurysms (AAA) involving the renovisceral arteries and to compare outcomes after fenestrated/branched endovascular aortic repair (f/b-EVAR), chimney/periscope EVAR (ch-EVAR), and bailout ch-EVAR.

Methods

A retrospective multicenter study including all patients with AAA involving the renovisceral segment, treated with f/b-EVAR, ch-EVAR, or bailout ch-EVAR, between 1 January 2005 and 30 June 2015, in three Swedish vascular centers. Patient charts were reviewed for data. Renovisceral stent graft patency was assessed on follow-up CT. Mortality was cross-checked against the Swedish Population Registry. Bailout ch-EVAR was defined as a perioperative decision of renovisceral endografting, as the artery was accidentally covered, or as the aneurysm neck sealing zone was considered inadequate.

Results

Of the 99 identified patients (76 men; mean age 74 years (range 58–89 years)), 68 underwent f/b-EVAR, 18 ch-EVAR, and 13 bailout ch-EVAR. Follow-up lasted for a median of 3.2 years (Q1, Q3 (2.1, 4.7 years)). Elective surgery comprised 87.9% (n = 87) of the cases. Six patients died within 30 days, and the 30-day mortality after elective surgery was 4.6% (95% CI, 1.3%–11.4%) overall, 1.6% after f/b-EVAR (95% CI, 0.0%–11.4%), 15.4% after ch-EVAR (95% CI, 1.9%–45.4%), and 10.0% (95% CI, 0.3%–44.5%) after bailout ch-EVAR. During follow-up, there were 16 secondary interventions, of which 75% (n = 12) were performed within six months after the primary intervention. Compared with f/b-EVAR, ch-EVAR was associated with a higher degree of type 1 endoleaks (1.5% vs. 22.2%, P = 0.001) and re-interventions during follow-up (13.2% vs. 33.3%, P = 0.046). The overall assisted target vessel patency was 96.1% (95% CI, 91.7%–98.6%) at one year and 95.2% (95% CI, 89.2%–98.4%) at two years.

Conclusions

Results after EVAR involving endografting of renovisceral arteries from three centers in Sweden with medium volumes are consistent with results previously reported from centers with larger volumes.

Keywords

Abdominal aortic aneurysm endovascular aneurysm repair patency mortality outcome analysis

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References

Volodos

Shekhanin

Karpovich

et al. A self-fixing synthetic blood vessel endoprosthesis. Vestn Khir Im I I Grek 1986; 137: 123–125.

Parodi

Palmaz

Barone

HD.

Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5: 491–499.

Park

Chung

Choo

et al. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: preliminary experience. J Vasc Interv Radiol 1996; 7: 819–823.

Verhoeven

Vourliotakis

Bos

et al. Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: an 8-year single-centre experience. Eur J Vasc Endovasc Surg 2010; 39: 529–536.

Roy

Millen

Jones

et al. Long-term follow-up of fenestrated endovascular repair for juxtarenal aortic aneurysm. Br J Surg 2017; 104: 1020–1027.

Anderson

Adam

Berce

et al. Repair of thoracoabdominal aortic aneurysms with fenestrated and branched endovascular stent grafts. J Vasc Surg 2005; 42: 600–607.

Ohrlander

Sonesson

Ivancev

et al. The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther 2008; 15: 427–432.

Lee

Greenberg

Dalman

RL.

Early experience with the snorkel technique for juxtarenal aneurysms. J Vasc Surg 2012; 55: 935–946. discussion 945–946.

Rancic

Pfammatter

Lachat

et al. Periscope graft to extend distal landing zone in ruptured thoracoabdominal aneurysms with short distal necks. J Vasc Surg 2010; 51: 1293–1296.

10.

Tinelli

Crea

de Waure

et al. A propensity-matched comparison of fenestrated endovascular aneurysm repair and open surgical repair of pararenal and paravisceral aortic aneurysms. J Vasc Surg 2018; 68: 659–668.

11.

Donas

Lee

Lachat

et al. Collected world experience about the performance of the snorkel/chimney endovascular technique in the treatment of complex aortic pathologies: the PERICLES registry. Ann Surg 2015; 262: 546–553. discussion 552–553.

12.

SWEDVASC. 2017 Annual report of the Swedish National Registry of Vascular Surgery (SWEDVASC). 2018, https://www.ucr.uu.se/swedvasc/arsrapporter.

13.

Killeen

Andrews

Redmond

et al. Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures. J Vasc Surg 2007; 45: 615–626.

14.

Scurr

McWilliams

RG.

Fenestrated aortic stent grafts. Semin Intervent Radiol 2007; 24: 211–220.

15.

Bjork

Grubb

Sterner

et al. Revised equations for estimating glomerular filtration rate based on the Lund-Malmo Study cohort. Scand J Clin Lab Invest 2011; 71: 232–239.

16.

Martin-Gonzalez

Pincon

Maurel

et al. Renal outcomes following fenestrated and branched endografting. Eur J Vasc Endovasc Surg 2015; 50: 420–430.

17.

Kristmundsson

Sonesson

Dias

et al. Outcomes of fenestrated endovascular repair of juxtarenal aortic aneurysm. J Vasc Surg 2014; 59: 115–120.

18.

Mastracci

Eagleton

Kuramochi

et al. Twelve-year results of fenestrated endografts for juxtarenal and group IV thoracoabdominal aneurysms. J Vasc Surg 2015; 61: 355–364.

19.

Budtz-Lilly J, Wanhainen A, Eriksson J, et al. Adapting to a total endovascular approach for complex aortic aneurysm repair: Outcomes after fenestrated and branched endovascular aortic repair. J Vasc Surg 2017; 66: 1349--1356.

20.

Lindblad

Bin Jabr

Holst

et al. Chimney grafts in aortic stent grafting: hazardous or useful technique? Systematic review of current data. Eur J Vasc Endovasc Surg 2015; 50: 722–731.

21.

Katsargyris

Oikonomou

Klonaris

et al. Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift? J Endovasc Ther 2013; 20: 159–169.

22.

Sveinsson

Sobocinski

Resch

et al. Early versus late experience in fenestrated endovascular repair for abdominal aortic aneurysm. J Vasc Surg 2015; 61: 895–901.

23.

Midy

Becquemin

Mialhe

et al. Results of the French Multicentric Study of ANACONDA fenestrated endografts in the treatment of complex aortic pathologies (EFEFA Registry). Ann Vasc Surg 2017; 43: 151–165.

24.

Donas

Torsello

Piccoli

et al. The PROTAGORAS study to evaluate the performance of the Endurant stent graft for patients with pararenal pathologic processes treated by the chimney/snorkel endovascular technique. J Vasc Surg 2016; 63: 1–7.