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Mid-term Outcomes of Physician-Modified Fenestrated or Branched Endovascular Repair for Post-dissection Thoracoabdominal Aortic Aneurysms

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

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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References

  1. Song JM, Kim SD, Kim JH, et al. Long- term predictors of descending aorta aneurysmal change in patients with aortic dissection. J Am Coll Cardiol. 2007;50:799–804.

    Article  PubMed  Google Scholar 

  2. Nordon IM, Hinchliffe RJ, Loftus IM, et al. Management of acute aortic syndrome and chronic aortic dissection. Cardiovasc Intervent Radiol. 2011;34:890–902.

    Article  PubMed  Google Scholar 

  3. Evangelista A, Salas A, Ribera A, et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation. 2012;125:3133–41.

    Article  PubMed  Google Scholar 

  4. Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013;61:1661–78.

    Article  PubMed  Google Scholar 

  5. Estrera AL, Sandhu HK, Afifi RO, et al. Early and late outcomes after complete aortic replacement. Ann Thorac Surg. 2015;100:528–34.

    Article  PubMed  Google Scholar 

  6. Nordon IM, Hinchliffe RJ, Holt PJ, et al. Modern treatment of juxtarenal abdominal aortic aneurysms with fenestrated endografting and open repair—a systematic review. Eur J Vasc Endovasc Surg. 2009;38:35–41.

    Article  CAS  PubMed  Google Scholar 

  7. Piazza M, Ricotta JJ 2nd. Open surgical repair of thoracoabdominal aortic aneurysms. Ann Vasc Surg. 2012;26(4):600–5.

    Article  PubMed  Google Scholar 

  8. Lobato AC, Camacho-Lobato L. A new technique to enhance endovascular thoraco-abdominal aortic aneurysm therapy-the sandwich procedure. Semin Vasc Surg. 2012;25(3):153–60.

    Article  PubMed  Google Scholar 

  9. Greenberg R, Eagleton M, Mastracci T. Branched endografts for thoraco-abdominal aneurysms. J Thorac Cardiovasc Surg. 2010;140(Suppl. 6):S171–8.

    Article  PubMed  Google Scholar 

  10. Bisdas T, Donas KP, Bosiers MJ, et al. Custom made versus off the shelf multibranched endografts for endovascular repair of thoraco-abdominal aortic aneurysms. J Vasc Surg. 2014;60(5):1186–95.

    Article  PubMed  Google Scholar 

  11. Starnes BW. Physician modified endovascular grafts for the treatment of elective, symptomatic, or ruptured juxtarenal aortic aneurysms. J Vasc Surg. 2012;56(3):601–7.

    Article  PubMed  Google Scholar 

  12. Starnes BW, Quiroga E. Hybrid-fenestrated aortic aneurysm repair: a novel technique for treating patients with paraanastomotic juxtarenal aneurysms. Ann Vasc Surg. 2010;24(8):1150–3.

    Article  PubMed  Google Scholar 

  13. Cochennec F, Kobeiter H, Gohel M, et al. Early results of physician modified fenestrated stent grafts for the treatment of thoraco-abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2015;50(5):583–92.

    Article  CAS  PubMed  Google Scholar 

  14. Verhoeven EL, Paraskevas KI, Oikonomou K, et al. Fenestrated and branched stentgrafts to treat post dissection chronic aortic aneurysms after initial treatment in the acute setting. J Endovasc Ther. 2012;19:343–9.

    Article  PubMed  Google Scholar 

  15. Kitagawa A, Greenberg RK, Eagleton MJ, et al. Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms. J Vasc Surg. 2013;58:625–34.

    Article  PubMed  Google Scholar 

  16. Yang G, Zhang M, Zhang Y, et al. Endovascular repair of post-dissection aortic aneurysms using physician-modified endografts. Ann Thorac Surg. 2021. https://doi.org/10.1016/j.athoracsur.2020.11.016.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fillinger MF, Greenberg RK, McKinsey JF, Chaikof EL. Society for vascular surgery Ad Hoc committee on TEVAR reporting standards. Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg. 2010;52(4):1022–33.

    Article  PubMed  Google Scholar 

  18. Chaikof EL, Blankensteijn JD, Harris PL, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg. 2002;35(5):1048–60.

    Article  PubMed  Google Scholar 

  19. von Allmen RS, Weiss S, Tevaearai HT, Kuemmerli C, Tinner C, Carrel TP, Schmidli J, Dick F. Completeness of follow-up determines validity of study findings: results of a prospective repeated measures cohort study. PLoS ONE. 2015;10(10): e0140817.

    Article  Google Scholar 

  20. Oderich GS, Ribeiro M, Hofer 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.

    Article  PubMed  Google Scholar 

  21. Oderich GS, Ribeiro MS, Sandri GA, et al. Evolution from physician-modified to company-manufactured fenestrated-branched endografts to treat pararenal and thoracoabdominal aortic aneurysms. J Vasc Surg. 2019;70(1):31-42.e7.

    Article  PubMed  Google Scholar 

  22. Sénémaud JN, Ben Abdallah I, de Boissieu P, et al. Intraoperative adverse events and early outcomes of custom-made fenestrated stent grafts and physician-modified stent grafts for complex aortic aneurysms. J Vasc Surg. 2020;71(6):1834-1842.e1.

    Article  PubMed  Google Scholar 

  23. Hiraoka T, Komiya T, Tsuneyoshi H, Shimamoto T. Risk factors for spinal cord ischaemia after thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg. 2018;27(1):54–9.

    Article  PubMed  Google Scholar 

  24. Kitpanit N, Ellozy SH, Connolly PH, Agrusa CJ, Lichtman AD, Schneider DB. Risk factors for spinal cord injury and complications of cerebrospinal fluid drainage in patients undergoing fenestrated and branched endovascular aneurysm repair. J Vasc Surg. 2021;73(2):399-409.e1.

    Article  PubMed  Google Scholar 

  25. Katsargyris A, Oikonomou K, Kouvelos G, Renner H, Ritter W, Verhoeven EL. Spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms with fenestrated and branched stent grafts. J Vasc Surg. 2015;62(6):1450–6.

    Article  PubMed  Google Scholar 

  26. Law Y, Tsilimparis N, Rohlffs F, Makaloski V, Behrendt CA, Heidemann F, Wipper SH, Debus ES, Kölbel T. Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm. J Vasc Surg. 2019;70(2):404–12.

    Article  PubMed  Google Scholar 

  27. Baba T, Ohki T, Maeda K. Current status of endovascular treatment for thoracoabdominal aortic aneurysms. Surg Today. 2020;50(11):1343–52.

    Article  PubMed  Google Scholar 

  28. Donas KP, Pecoraro F, Torsello G, Lachat M, Austermann M, Mayer D, Panuccio G, Rancic Z. Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks. J Vasc Surg. 2012;55(3):659–65.

    Article  PubMed  Google Scholar 

  29. Eagleton MJ, Farivar B, Dias A. Large, single-center databases and the evolution of endovascular therapy for complex aortic aneurysms. Surgery. 2017;162(5):963–73.

    Article  PubMed  Google Scholar 

  30. Premprabha D, Sobel J, Pua C, et al. Visceral branch occlusion following aneurysm repair using multibranched thoracoabdominal stent-grafts. J Endovasc Ther. 2014;21(6):783–90.

    Article  PubMed  Google Scholar 

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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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Authors and Affiliations

  1. Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China

    Xiaohui Wang, Qianqian Zhu, Yangyan He, Tao Shang, Yilang Xiang, Qinglong Zeng, Donglin Li, Ziheng Wu, Lu Tian, Zhenjiang Li & Hongkun Zhang

Authors
  1. Xiaohui Wang
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  2. Qianqian Zhu
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  3. Yangyan He
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  4. Tao Shang
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  5. Yilang Xiang
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  6. Qinglong Zeng
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  7. Donglin Li
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  11. Hongkun Zhang
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Contributions

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.

Corresponding authors

Correspondence to Zhenjiang Li or Hongkun Zhang.

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The authors declare that they have no conflict of interest.

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 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, formal consent is not required. The study was approved by institutional ethics committee of our hospital.

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

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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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