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Custom-Made Endograft for Endovascular Repair of Thoraco-Abdominal Aneurysm and Type B Dissection: Single-Centre Experience.

Abstract：

AIMS:To report a series of patients treated with the Jotec custom-made endograft for thoraco-abdominal aneurysms and dissections and identify predictive factors for re-intervention. METHODS:We retrospectively analysed 49 patients unsuitable for surgery, treated between 2011 and 2017 (71.3 ± 9.5 years; 15 females). Indications included Crawford type 4 aneurysm in 25 patients, type 3 in 13, type 2 in 4, type 1 in 2 and chronic aneurysmal dilatation of the false lumen following dissection in 5 cases. Mean aneurysm diameter was 58.7 ± 8.4 mm. The study aims were to assess procedural success, complications rate, mortality and long-term follow-up. We also analysed factors that predicted the need for re-intervention. RESULTS:The endograft was successfully deployed in all patients, catheterization of the fenestration and/or branches was achieved in 152/156 (97.4%) vessels. Early complications occurred in 10 patients (3 paraplegia, 3 haemorrhages, pancreatitis, aortic rupture, iliac artery rupture, 2 strokes). Thirty-day mortality was 10.2% and 180-day mortality 14.3%; two non procedure related deaths occurred. Mean follow-up was 23.6 ± 29.9 months [range 1-80]. No patients needed surgical explantation or developed significant renal impairment. Endoleak rate was 34.6% and re-intervention rate 9.7%. The aneurysm sac reduced or was stable in 36/49, and enlarged in 9/49 patients prompting re-intervention. Primary, primary-assisted and secondary patency of fenestrations/branches at 80 months was 90, 96 and 100%. Re-intervention was required more frequently in braches than in fenestrations, most commonly the external type branches. CONCLUSIONS:The results of the Jotec endograft are comparable to other devices, with acceptable complication and re-intervention rates. Fenestration and inner-branch should be preferred due to lower re-intervention rates.

journal_name

Cardiovasc Intervent Radiol

journal_title

Cardiovascular and interventional radiology

authors

Lucatelli P,Cini M,Benvenuti A,Saba L,Tommasino G,Guaccio G,Munneke G,Neri E,Ricci C

doi

10.1007/s00270-018-1975-3

subject

Has Abstract

pub_date

2018-08-01 00:00:00

pages

1174-1183

issue

eissn

0174-1551

issn

1432-086X

pii

10.1007/s00270-018-1975-3

journal_volume

pub_type

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Custom-Made Endograft for Endovascular Repair of Thoraco-Abdominal Aneurysm and Type B Dissection: Single-Centre Experience.