Clinical Study On Endovascular Treatment Of Thoracoabdominal Aorta Aneurysm

Part I Comparison of physician-modified fenestrated–branched endografts and visceral debranching plus stenting for complex thoracoabdominal aortic aneurysm repairObjectives: To evaluate the immediate postoperative and midterm outcomes of complex aortic aneurysm treatments with physician-modified fenestrated and branched endografts(PMEGs)or visceral debranching plus stenting(hybrid).Methods: Clinical data of patients with a complex aortic aneurysm that necessitated vessel revascularization between 2017 and 2019 were used.Results: In total,88 patients(73 men [83%],mean age,70.0 ± 10.6 years)presented with complex thoracoabdominal aortic aneurysms and were treated with PMEGs(60patients [68%])or the hybrid technique(28 patients [32%]).The mean maximum aneurysm diameter was 64.5 ± 11.7 mm,and 37(42%)patients were symptomatic.In the PMEG group,the main physician-modified stent grafts were Zenith TX2 stent grafts and Ankura stent grafts.In total,233 targets were addressed(technical success rate,97.9% [228 targets]).Fenestrations,branches,and their combination were applied in 35,8,and 17 cases,respectively.In 28 cases in the hybrid group(32%),a two-stage technique was undertaken.All target vessels were successfully revascularized with 110 bypasses.Further,30-day mortality was 3.4%,and the early occlusion/stenosis rate in target vessels was 3.3%(5 in PMEG group and 6 in the hybrid group).According to multivariate analysis,the hybrid technique was independently associated with higher early and late morbidity.The 30-day morbidity was mainly attributed to pulmonary complications(14.8%),lower limb ischemia(7.9%),or SCI with paraplegia(5.7%).Eleven patients(12.5%)had deteriorated renal function with a >30% decrease in the glomerular filtration rate at the late follow-up.The mean follow-up period was 22.3 ± 4.9 months,and mortality was 4.5%(3.3% in the PMEG group vs.7.1% in the hybrid group).Conclusions: PMEGs and hybrid techniques seem to be feasible treatment options for aortic aneurysms necessitating visceral vessel revascularization.PMEGs may have a lower morbidity than the hybrid technique.The hybrid technique remains an important technique that should be among the options available for complex aortic aneurysms.Part II Endovascular treatment of thoracoabdominal aortic aneurysm using physician modified Ankura endograftsObjective : To evaluate the early results of preprocedural fenestrated technique of thoracoabdominal aortic aneurysms(TAAAs)using physician-modified Ankura endografts(PMEGs).Method:58 consecutive patients who underwent F/B-EVAR using PMEGs between January 2017 and December 2019 was retrospectively reviewed.The perioperative mortality and morbidity of the F/B-EVAR technique was assessed and the early results of follow up were evaluated.Results:The median age of patients was 65.3 years old(range,48-83years),and 48 of58(82.8%)patients were male.There were 22 cases of aortic aneurysm and 36 cases of post aortic dissection aneurysm.Initial technical success rate of vesical revascularization was 98.9%(180 of 182).There were no in-hospital death or no peri-operative neurology complications.One patient had failed reconstruction of the left renal artery during operation(blood supply from the distal tear and reconstructed successfully after 3 months).Procedure time averaged 260.2±66.3 min with a mean volume of blood loss 187.5±113.1 ml.The mean volume of contrast utilized was151.2 ± 20.5 ml.The mean fluoroscopy time was 56.3 ± 16.6 min.The mean postoperative ICU stay was 2.3±1.2 days.The mean postoperative hospital stay was6.8±5.3days.Conclusion : F/B-EVAR using PMEGs may be available alternative for high risk patients with TAAAs.Part III Comparison of outcomes for fenestrated-branched stent grafts in the treatment of degenerative thoracoabdominal aortic aneurysms versus post dissection aneurysmObjectives: The purpose of this study was to compare the outcomes of fenestrated-branched endovascular aneurysm repair(F/B-EVAR)in the management of degenerative thoracoabdominal aortic aneurysms(TAAAs)versus post dissection aneurysm.Materials and Methods: The clinical data for a total of 106 patients with degenerative TAAAs(DG-TAAAs)and post dissection TAAAs(Post-TAAAs)at a single institution between 2017 and 2020 were included.All patients had physician modified stent-grafts(PMSGs).Early outcomes included technical success,perioperative mortality,major advent events.Late outcomes included reintervention,endoleak and survival.Results: Post-TAAAs patients were significantly younger and had a higher incidence of prior endovascular aortic repair or prior open aortic repair.There were significant differences in aneurysm diameter for extent III,extent IV,and ASA IV.Technique success was 98.9% for Post-TAAAs and 96.3% for DG-TAAAs(P=.09).The 30-day mortality was significantly higher in the DG-TAAAs 11.4% compared to the post-TAAAs 1.6%(P=.03).Strokes were significantly more frequent in patients with degenerative TAAAs(11.3%)compared with post dissection TAAAs(1.6%;P=.03).Type III endoleaks were significantly more frequent in patients with post-TAAAs(14.8%)compared with degenerative TAAAs(2.6%;P=.04).Reinterventions were significantly more frequent in patients with post-TAAAs(19.7%)compared with degenerative TAAAs(5.2%;P=.04).Conclusions: The early mortality of degenerative TAAAs was higher compared with post dissection TAAAs.Strokes were more common in degenerative TAAAs.Post dissection TAAAs had more endoleaks and reinterventions during follow-up.More extensive investigations of clinical experience and longer follow-ups are required in the future.