Study Evaluates Fenestrated and Branched Endovascular Repair of Complex AAAs and TAAAs

 

September 6, 2017—Outcomes of fenestrated and branched endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms in a single-center prospective, observational cohort study were published by Andres Schanzer, MD, et al in Journal of Vascular Surgery (2017;66:687–694).

The investigators explained that the background of the study is that more than 80% of infrarenal aortic aneurysms are treated by endovascular repair. However, adoption of fenestrated and branched endovascular repair for complex aortic aneurysms has been limited, despite high morbidity and mortality associated with open repair. There are few published reports of consecutive outcomes, inclusive of all fenestrated and branched endovascular repairs, starting from the inception of a complex aortic aneurysm program. Therefore, the investigators examined a single center's consecutive experience of fenestrated and branched endovascular repair of complex aortic aneurysms.

As summarized in Journal of Vascular Surgery, the study evaluated 30-day and 1-year outcomes in all consecutive patients who underwent fenestrated and branched endovascular repair of complex aortic aneurysms (defined as requiring one or more fenestrations or branches). Data were collected prospectively through an Institutional Review Board-approved registry and a physician-sponsored investigational device exemption clinical trial (G130210), registered as clinical trial NCT02050113, CARPE-CMD (Complex Aortic Aneurysm Repair Using Physician Modified Endografts and Custom Made Devices).

The investigators performed 100 consecutive complex endovascular aortic aneurysm repairs (November 2010–March 2016) using 58 (58%) commercially manufactured custom-made devices and 42 (42%) physician-modified devices to treat four (4%) common iliac, 42 (42%) juxtarenal, 18 (18%) pararenal, and 36 (36%) thoracoabdominal aneurysms (type I, n = 1; type II, n = 4; type III, n = 12; type IV, n = 18; arch, n = 1).

The repairs included 309 fenestrations, branches, and scallops (average of 3.1 branch arteries/case). All patients had 30-day follow-up for 30-day event rates: three (3%) deaths, six (6%) target artery occlusions, five (5%) progressions to dialysis, eight (8%) access complications, one (1%) paraparesis, one (1%) bowel ischemia, and no instances of myocardial infarction, paralysis, or stroke. Of the 10 type I or type III endoleaks, eight resolved (seven with secondary intervention, one without intervention). Mean follow-up time was 563 days (interquartile range, 156–862), with three (3%) patients lost to follow-up.

At the 1-year Kaplan-Meier analysis, survival was 87%, freedom from type I or type III endoleak was 97%, target vessel patency was 92%, and freedom from aortic rupture was 100%. Average lengths of intensive care unit stay and inpatient stay were 1.4 days (standard deviation, 3.3) and 3.6 days (standard deviation, 3.6), respectively.

These results showed that complex aortic aneurysms can now be treated with minimally invasive fenestrated and branched endovascular repair; additionally, endovascular technologies will likely continue to play an increasingly important role in the management of patients with complex aortic aneurysm disease, concluded the investigators in Journal of Vascular Surgery.

 

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