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

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

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.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA

    Julia Chini, Bernardo C. Mendes, Emanuel R. Tenorio, Mauricio S. Ribeiro, Giuliano A. Sandri, Stephen Cha, Jan Hofer & Gustavo S. Oderich

  2. Division of Vascular and Endovascular Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil

    Mauricio S. Ribeiro

  3. Gonda Vascular Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Gustavo S. Oderich

Authors
  1. Julia Chini
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  2. Bernardo C. Mendes
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  3. Emanuel R. Tenorio
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  4. Mauricio S. Ribeiro
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  5. Giuliano A. Sandri
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  6. Stephen Cha
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  7. Jan Hofer
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  8. Gustavo S. Oderich
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Corresponding author

Correspondence to Gustavo S. Oderich.

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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.

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

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Chini, J., Mendes, B.C., Tenorio, E.R. et al. Preloaded Catheters and Guide-Wire Systems to Facilitate Catheterization During Fenestrated and Branched Endovascular Aortic Repair. Cardiovasc Intervent Radiol 42, 1678–1686 (2019). https://doi.org/10.1007/s00270-019-02322-6

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  • DOI: https://doi.org/10.1007/s00270-019-02322-6

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