Endoleak outcomes with different stent-graft generations in a 25-years thoracic endovascular aortic repair experience

Abstract

Introduction

To compare endoleak outcomes after thoracic endovascular aneurysm repair (TEVAR) with different stent-graft generations into long-term follow-up.

Design

retrospective, observational, and single-center cohort study.

Methods

TEVAR procedures performed between November 1995 and December 2020 were analyzed. The primary endpoint of this study was the freedom from endoleak (type I/III) in four stent-graft generations during the follow-up period. The first generation (GEN1) included: Vanguard; AneuRx and Talent; Stentor; Excluder; Endologix; EndoFit. The second generation (GEN2) included: TAG and TX. The third (GEN3) included: Relay Plus; Valiant Captivia; Zenith Alpha and custom-made. The fourth (GEN4) included: Relay Pro; Conformable C-TAG; Navion; E-Vita; Najuta; Nexus; standard and custom-made thoraco-abdominal devices. Nonaortic and aorta-related survival was considered as secondary outcome.

Results

A total of 509 TEVAR were included with a 44.3 ± 42.5 months mean follow-up. Freedom from endoleak at 5 years was 65.6%, 61.4%, 76.2%, and 69.1% for GEN1, GEN2, GEN3, and GEN4, respectively (p = 0.368). The first two generations demonstrated a higher endoleak rate when compared with the two most recent ones (27.2 vs 18.2%, respectively; p = 0.043). GEN1 was an independent risk factor (p = 0.014) and GEN4 was an independent protective factor (p = 0.001) for endoleak. GEN1 was found to be a risk factor for type-Ia endoleak (p = 0.059). GEN4 demonstrated a protective association regarding type-Ib endoleak (p = 0.012). Overall survival was 75.3%, 44.4%, 27.2%, and 17.6% at 1, 5, 10, and 15 years, respectively. Survival distinguished as non-related versus aortic-related was 86.7% vs 23.5%, 52.7% vs 9.8%, 32.9% vs 2.0%, 21.2% vs 0% at 1, 5, 10, and 15 years, respectively (p< 0.000).

Conclusion

Endoleak occurred in a non-negligible percentage of TEVAR patients. A significant reduction of endoleak incidence over evolving stent-grafts generations was registered. Newer stent-graft generations demonstrated better long-term endoleak. Data about long-term outcomes require ongoing updates to prove both the reliability and the durability of newer stent-graft generations.

Keywords

Aneurysm endovascular technique endoleak stent-graft thoracic aorta

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References

Dake

Miller

Semba

, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994; 331: 1729–1734.

Riambau

Böckler

Brunkwall

, et al. Editor’s choice–management of descending thoracic aorta diseases. Eur J Vasc Endovasc Surg 2017; 53: 4–52.

Bicknell

Powell

. Aortic disease: thoracic endovascular aortic repair. Heart Br Card Soc 2015; 101: 586–591.

Silingardi

Gennai

Leone

, et al. Standard “off-the-shelf” multibranched thoracoabdominal endograft in urgent and elective patients with single and staged procedures in a multicenter experience. J Vasc Surg 2018; 67: 1005–1016.

Silingardi

Gennai

Coppi

, et al. Contemporary economic and clinical evaluations of endovascular repair for intact descending thoracic aortic aneurysms. J Cardiovasc Surg (Torino) 2017; 58: 835–844.

Gennai

Leone

Andreoli

, et al. Influence of thoracic endovascular repair on aortic morphology in patients treated for blunt traumatic aortic injuries: long term outcomes in a multicentre study. Eur J Vasc Endovasc Surg 2020; 59: 428–436.

Mezzetto

Scorsone

Silingardi

, et al. Early and long-term results of ePTFE (gore TAG®) versus dacron (relay plus® bolton) grafts in thoracic endovascular aneurysm repair. Ann Vasc Surg 2021; 71: 419–427.

Patel

Williams

Drews

, et al. A 20-year experience with thoracic endovascular aortic repair: Ann Surg 2014; 260: 691–697.

Ziza

Canaud

Molinari

, et al. Thoracic endovascular aortic repair: a single center’s 15-year experience. J Thorac Cardiovasc Surg 2016; 151: 1595–1603.e7.

10.

Czerny

Funovics

Sodeck

, et al. Long-term results of thoracic endovascular aortic repair in atherosclerotic aneurysms involving the descending aorta. J Thorac Cardiovasc Surg 2010; 140: S179–S184.

11.

Wiedemann

Mahr

Vadehra

, et al. Thoracic endovascular aortic repair in 300 patients: long-term results. Ann Thorac Surg 2013; 95: 1577–1583.

12.

Fillinger

Greenberg

McKinsey

, et al. Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg 2010; 52: 1022–1033.e5.

13.

Oderich

Forbes

Chaer

, et al. Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries. J Vasc Surg 2021; 73: 4S–52S.

14.

Lombardi

Co-Chair

. Society for vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg 2020; 71: 25.

15.

Bischoff

Ante

Meisenbacher

, et al. Outcome of thoracic endovascular aortic repair in patients with thoracic and thoracoabdominal aortic aneurysms. J Vasc Surg 2016; 63: 1170–1181.e1.

16.

Schaffer

Lingala

Miller

, et al. Midterm survival after thoracic endovascular aortic repair in more than 10,000 Medicare patients. J Thorac Cardiovasc Surg 2015; 149: 808–823.

17.

Lee

Daniels

Beaver

, et al. Late outcomes of a single-center experience of 400 consecutive thoracic endovascular aortic repairs. Circulation 2011; 123: 2938–2945.

18.

Ranney

Cox

Yerokun

, et al. Long-term results of endovascular repair for descending thoracic aortic aneurysms. J Vasc Surg 2018; 67: 363–368.

19.

Alhussaini

Arnaoutakis

Scali

, et al. Impact of secondary aortic interventions after thoracic endovascular aortic repair on long-term survival. Ann Thorac Surg 2020; 110: 27–38.

20.

Canaud

Cathala

Joyeux

, et al. Improvement in conformability of the latest generation of thoracic stent grafts. J Vasc Surg 2013; 57: 1084–1089.

21.

Belvroy

de Beaufort

HWL

van Herwaarden

, et al. Type 1b Endoleaks after thoracic endovascular aortic repair are inadequately reported: a systematic review. Ann Vasc Surg 2020; 62: 474–483.

22.

Belvroy

Romarowski

van Bakel

TMJ

, et al. Impact of aortic tortuosity on displacement forces in descending thoracic aortic aneurysms. Eur J Vasc Endovasc Surg 2020; 59: 557–564.