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CardioVascular and Interventional Radiology

, Volume 42, Issue 12, pp 1678–1686 | Cite as

Preloaded Catheters and Guide-Wire Systems to Facilitate Catheterization During Fenestrated and Branched Endovascular Aortic Repair

  • Julia Chini
  • Bernardo C. Mendes
  • Emanuel R. Tenorio
  • Mauricio S. Ribeiro
  • Giuliano A. Sandri
  • Stephen Cha
  • Jan Hofer
  • Gustavo S. OderichEmail author
Clinical Investigation Arterial Interventions
  • 97 Downloads
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Objective

The aim of this study was to review the clinical outcomes for patients treated for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs) by fenestrated–branched endovascular aortic repair (F-BEVAR) using preloaded systems (PLS).

Methods

We reviewed clinical data of 83 patients (64 male, mean age 75 ± 7 years) enrolled in a prospective study to investigate F-BEVAR. All patients had PLS, which included two catheters or two through-and-through guide wires with 12-Fr trans-brachial sheaths positioned in the descending thoracic aorta. Outcome measurements were technical success defined as successful deployment of the main fenestrated stent graft and cannulation of all target vessels, total endovascular time, total lower extremity ischemia time and complications, 30-day mortality, and major adverse events (MAEs).

Results

Aneurysm extent was PRA in 27 patients and TAAA in 56 (35 extent IV and 21 extent I–III). A total of 333 target vessels were incorporated with an average of 4 ± 0.4 vessels per patient. Technical success was 99.7%. Total endovascular time was 160 ± 51 min. Sixty-five (78%) patients had motor and somatosensory evoked potentials monitoring, and lower extremity ischemia time was 115 ± 42 min. There were no 30-day mortalities. Fifteen patients (18%) had MAEs, including three (3.6%) minor ischemic strokes. There were no upper extremity complications. All ischemic strokes occurred in female patients (3.6% vs. 0%, P = .001). One (1.2%) patient had paraplegia.

Conclusion

This study shows high technical success and early lower limb reperfusion using PLS with trans-brachial access. The risk of stroke, especially in female patients, should be carefully assessed by review of preoperative arch imaging.

Keywords

Fenestrated and branched endovascular repair Preloaded catheter Complex aortic aneurysm Thoracoabdominal aortic aneurysm 

Notes

Funding

This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

Dr. Oderich has received consulting fees and grants from Cook Medical, W. L. Gore, and GE Healthcare (all paid to Mayo Clinic with no personal income). The other authors declare no conflict of interest.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Oderich GS, Ribeiro M, Hofer J, Wigham J, Cha S, Chini J, et al. Prospective, nonrandomized study to evaluate endovascular repair of pararenal and thoracoabdominal aortic aneurysms using fenestrated–branched endografts based on supraceliac sealing zones. J Vasc Surg. 2017;65(5):1249–59 e10.CrossRefGoogle Scholar
  2. 2.
    Mastracci TM, Greenberg RK, Eagleton MJ, Hernandez AV. Durability of branches in branched and fenestrated endografts. J Vasc Surg. 2013;57(4):926–33.CrossRefGoogle Scholar
  3. 3.
    Oderich GS, Greenberg RK, Farber M, Lyden S, Sanchez L, Fairman R, et al. Results of the United States multicenter prospective study evaluating the Zenith fenestrated endovascular graft for treatment of juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2014;60(6):1420–8 e5.CrossRefGoogle Scholar
  4. 4.
    Verhoeven E, Katsargyris A, Oikonomou K, Kouvelos G, Renner H, Ritter W. Fenestrated endovascular aortic aneurysm repair as a first line treatment option to treat short necked, juxtarenal, and suprarenal aneurysms. Eur J Vasc Endovasc Surg. 2016;51(6):775–81.CrossRefGoogle Scholar
  5. 5.
    Maurel B, Delclaux N, Sobocinski J, Hertault A, Martin-Gonzalez T, Moussa M, et al. Editor’s choice—the impact of early pelvic and lower limb reperfusion and attentive peri-operative management on the incidence of spinal cord ischemia during thoracoabdominal aortic aneurysm endovascular repair. Eur J Vasc Endovasc Surg. 2015;49(3):248–54.CrossRefGoogle Scholar
  6. 6.
    Banga PV, Oderich GS, Reis de Souza L, Hofer J, Cazares Gonzalez ML, Pulido JN, et al. Neuromonitoring, cerebrospinal fluid drainage, and selective use of iliofemoral conduits to minimize risk of spinal cord injury during complex endovascular aortic repair. J Endovasc Ther. 2016;23(1):139–49.CrossRefGoogle Scholar
  7. 7.
    Etz CD, Kari FA, Mueller CS, Silovitz D, Brenner RM, Lin H-M, et al. The collateral network concept: a reassessment of the anatomy of spinal cord perfusion. J Thorac Cardiovasc Surg. 2011;141(4):1020–8.CrossRefGoogle Scholar
  8. 8.
    Tenorio ER, Eagleton MJ, Kärkkäinen JM, Oderich GS. Prevention of spinal cord injury during endovascular thoracoabdominal repair. J Cardiovasc Surg. 2019;60(1):54–65.Google Scholar
  9. 9.
    Oderich GS, Mendes BC, Correa MP. Preloaded guidewires to facilitate endovascular repair of thoracoabdominal aortic aneurysm using a physician-modified branched stent graft. J Vasc Surg. 2014;59(4):1168–73.CrossRefGoogle Scholar
  10. 10.
    Manning BJ, Harris PL, Hartley DE, Ivancev K. Preloaded fenestrated stent-grafts for the treatment of juxtarenal aortic aneurysms. J Endovasc Ther. 2010;17(4):449–55.CrossRefGoogle Scholar
  11. 11.
    Verhoeven EL. The first phase of another exciting chapter in the development of fenestrated stent-grafts: preloaded devices. J Endovasc Ther. 2010;17(4):456.CrossRefGoogle Scholar
  12. 12.
    Chaikof EL, Blankensteijn JD, Harris PL, White GH, Zarins CK, Bernhard VM, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg. 2002;35(5):1048–60.CrossRefGoogle Scholar
  13. 13.
    Fillinger MF, Greenberg RK, McKinsey JF, Chaikof EL. Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg. 2010;52(4):1022–33 e5.CrossRefGoogle Scholar
  14. 14.
    Eagleton MJ, Follansbee M, Wolski K, Mastracci T, Kuramochi Y. Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms. J Vasc Surg. 2016;63(4):930–42.CrossRefGoogle Scholar
  15. 15.
    Katsargyris A, Oikonomou K, Kouvelos G, Mufty H, Ritter W, Verhoeven EL. 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.CrossRefGoogle Scholar
  16. 16.
    Eagleton MJ, Shah S, Petkosevek D, Mastracci TM, Greenberg RK. Hypogastric and subclavian artery patency affects onset and recovery of spinal cord ischemia associated with aortic endografting. J Vasc Surg. 2014;59(1):89–95.CrossRefGoogle Scholar
  17. 17.
    Fiorucci B, Kölbel T, Rohlffs F, Heidemann F, Debus SE, Tsilimparis N. Right brachial access is safe for branched endovascular aneurysm repair in complex aortic disease. J Vasc Surg. 2017;66(2):360–6.CrossRefGoogle Scholar
  18. 18.
    Ribeiro M, Oderich GS, Macedo T, Vrtiska TJ, Hofer J, Chini J, et al. Assessment of aortic wall thrombus predicts outcomes of endovascular repair of complex aortic aneurysms using fenestrated and branched endografts. J Vasc Surg. 2017;66(5):1321–33.CrossRefGoogle Scholar
  19. 19.
    Mirza AK, Oderich GS, Sandri GA, Tenorio ER, Davila VJ, Kärkkäinen JM, et al. Outcomes of upper extremity access during fenestrated–branched endovascular aortic repair. J Vasc Surg. 2019;69(3):635–43.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Julia Chini
    • 1
  • Bernardo C. Mendes
    • 1
  • Emanuel R. Tenorio
    • 1
  • Mauricio S. Ribeiro
    • 1
    • 2
  • Giuliano A. Sandri
    • 1
  • Stephen Cha
    • 1
  • Jan Hofer
    • 1
  • Gustavo S. Oderich
    • 1
    • 3
    Email author
  1. 1.Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular SurgeryMayo ClinicRochesterUSA
  2. 2.Division of Vascular and Endovascular Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical SchoolUniversity of São PauloSão PauloBrazil
  3. 3.Gonda Vascular CenterMayo ClinicRochesterUSA

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