Abstract
Purpose
To report the early experience and mid-term outcomes of physician-modified fenestrated or branched endovascular repair (PM-F/BEVAR) for patients with post-dissection thoracoabdominal aortic aneurysm (PD-TAAA).
Methods
PD-TAAA patients treated with PM-F/BEVAR between December 2014 and September 2020 in our institution were retrospectively analyzed.
Results
Out of the 39 patients, technical success defined as successful deployment of all stent grafts with patent target vessels (TVs) and exclusion of the lesion without type I or III endoleak was achieved in 35 patients (89.7%). A total of 126 TVs were successfully reconstructed. Thirty-day mortality was 0%. Seven major adverse events occurred including one acute kidney injury, four renal infarctions, one retroperitoneal hematoma and one left renal artery occlusion. Seven type II endoleak and three type III endoleak were detected. During a mean 29.4 ± 15.5 months follow-up period, the mortality was zero. Three renal arteries and one external iliac artery occluded in four patients. No other new onset major adverse event occurred. No patient required reintervention. One type II endoleak spontaneously resolved, while the remaining six remained stable. One early type III endoleak diminished, and one new type III endoleak occurred at 2 months. The primary patency of TV was 96.8% (120/124). Shrinkage or stability of aneurysm diameter can be observed in 38 patients (97.4%). The false lumen thrombosis rate was 89.7% (35/39).
Conclusions
The present study showed encouraging results of PM-F/BEVAR for treatment of PD-TAAAs.
Level of Evidence
Level 4, Case Series.
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Funding
This study was funded by the National Natural Science Foundations of China (Grant No. 82000430), Major Science and Technology Project in Medical and Health of Zhejiang Province (co-constructed Project by Province and the Ministry, Grant No. 2020380400, WKJ-ZJ-2003), Key R&D Program of Zhejiang province (Grant No. 2019C03013) and the Health project of Zhejiang Province (Grant No. 2021KY673).
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Seven authors have contributed significantly to the submitted work. The contribution of each author is as follows: Hongkun Zhang, Zhenjiang Li contributed to conception and design; Xiaohui Wang, Zhenjiang Li, Yangyan He, Yilang Xiang, and Tao Shang contributed to analysis and interpretation of data; Xiaohui Wang, Zhenjiang Li and Qianqian Zhu contributed to writing the article; Donglin Li, Lu Tian, and Hongkun Zhang contributed to critical revision of the article; Qianqian Zhu, Qinglong Zeng, and Ziheng Wu contributed to statistical analysis; Zhenjiang Li, Hongkun Zhang and Donglin Li obtained funding.
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Xiaohui Wang and Qianqian Zhu contributed equally to this work.
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Wang, X., Zhu, Q., He, Y. et al. Mid-term Outcomes of Physician-Modified Fenestrated or Branched Endovascular Repair for Post-dissection Thoracoabdominal Aortic Aneurysms. Cardiovasc Intervent Radiol 45, 1672–1681 (2022). https://doi.org/10.1007/s00270-022-03232-w
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DOI: https://doi.org/10.1007/s00270-022-03232-w