Pierleone Lucatelli1,2, Marco Cini3, Antonio Benvenuti4, Luca Saba5, Giulio Tommasino4, Giulia Guaccio4, Graham Munneke6, Eugenio Neri4, Carmelo Ricci3. 1. Vascular and Interventional Radiology Unit, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100, Siena, Italy. pierleone.lucatelli@gmail.com. 2. Vascular and Interventional Radiology Unit, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy. pierleone.lucatelli@gmail.com. 3. Vascular and Interventional Radiology Unit, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100, Siena, Italy. 4. Cardiac and Great Vessels Surgery Unit, University of "Siena", Viale Mario Bracci, 16, 53100, Siena, Italy. 5. Department of Radiology, Azienda Ospedaliero Universitaria (AOU), di Cagliari - Polo di Monserrato s.s. 554, 09045, Monserrato (Cagliari), Italy. 6. University College, London Hospital, London, UK.
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.
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.
Entities:
Keywords:
EVAR; Endovascular repair; TEVAR; Thoraco-abdominal aneurysm; Type B dissection; b-EVAR; f-EVAR