Said Abisi1, Vassilios Zymvragoudakis2, Panos Gkoutzios3, Morad Sallam2, Tommaso Donati2, Prakash Saha2, Hany Zayed2. 1. Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: said.abisi@gstt.nhs.uk. 2. Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK. 3. Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Abstract
OBJECTIVE: Complex aortic endografts have evolved to include inner branches to overcome specific challenges with existing technologies. Here we report the early outcomes of endovascular aortic repairs using a Jotec inner branched endograft (iBEVAR). METHODS: All patients undergoing complex endovascular aortic repairs using Extra-design Engineering iBEVAR (Jotec GmbH, Hechingen, Germany) between 2018 until 2020 at a single centre were reviewed. Patient demographics, cardiovascular risk factors, anatomical features of the aneurysms and target vessels were recorded. Reasons for using inner branches over fenestrated and standard branched endografts, procedural details, outcomes, and re-intervention during follow up were examined. RESULTS: A total of 110 patients were treated with branched and fenestrated endografts during the study period, of which 18 patients had a patient specific "custom-made" iBEVAR endograft with downward inner branches. Technical success rate was 100%. Some 68 target vessels were cannulated and bridging stent grafts were placed successfully in all. Reasons for choosing iBEVAR design included unfavourable target vessel trajectory for fenestrated repair (n= 15); excessive infra renal aortic angulation/adverse iliac access vessels for fenestrated repair (n=11); presence of a narrow aortic lumen (n=14), and/or; to reduce aortic coverage compared to standard outer branched repair (n=14). We also used iBEVAR to treat type 1A endoleaks following failed EVAR with a short main body (n=5). The median contrast volume used was 120 ml (48-200) with a median fluoroscopy screening time 66 mins (35-136) and median dose area product (DAP) 17832 dGycm2 (8260-55070). There was no 30-day mortality and no major complications. There was one early intervention for a suspected type 1B endoleak from an iliac limb and one late intervention for in-stent stenosis in a renal bridging stent graft. There was one non-aortic related death at 3 months. All other patients remained under follow up with their aneurysms excluded with patent target vessels, and no type I or III endoleak identified at median follow up 12 months (1-26) months. CONCLUSION: Jotec Extra-design Engineering endografts incorporating downward inner branches have a satisfactory early outcome with low reintervention rate. The technology has potential to be a useful addition to our armamentarium of complex aortic endografts however long-term outcome data are needed.
OBJECTIVE: Complex aortic endografts have evolved to include inner branches to overcome specific challenges with existing technologies. Here we report the early outcomes of endovascular aortic repairs using a Jotec inner branched endograft (iBEVAR). METHODS: All patients undergoing complex endovascular aortic repairs using Extra-design Engineering iBEVAR (Jotec GmbH, Hechingen, Germany) between 2018 until 2020 at a single centre were reviewed. Patient demographics, cardiovascular risk factors, anatomical features of the aneurysms and target vessels were recorded. Reasons for using inner branches over fenestrated and standard branched endografts, procedural details, outcomes, and re-intervention during follow up were examined. RESULTS: A total of 110 patients were treated with branched and fenestrated endografts during the study period, of which 18 patients had a patient specific "custom-made" iBEVAR endograft with downward inner branches. Technical success rate was 100%. Some 68 target vessels were cannulated and bridging stent grafts were placed successfully in all. Reasons for choosing iBEVAR design included unfavourable target vessel trajectory for fenestrated repair (n= 15); excessive infra renal aortic angulation/adverse iliac access vessels for fenestrated repair (n=11); presence of a narrow aortic lumen (n=14), and/or; to reduce aortic coverage compared to standard outer branched repair (n=14). We also used iBEVAR to treat type 1A endoleaks following failed EVAR with a short main body (n=5). The median contrast volume used was 120 ml (48-200) with a median fluoroscopy screening time 66 mins (35-136) and median dose area product (DAP) 17832 dGycm2 (8260-55070). There was no 30-day mortality and no major complications. There was one early intervention for a suspected type 1B endoleak from an iliac limb and one late intervention for in-stent stenosis in a renal bridging stent graft. There was one non-aortic related death at 3 months. All other patients remained under follow up with their aneurysms excluded with patent target vessels, and no type I or III endoleak identified at median follow up 12 months (1-26) months. CONCLUSION: Jotec Extra-design Engineering endografts incorporating downward inner branches have a satisfactory early outcome with low reintervention rate. The technology has potential to be a useful addition to our armamentarium of complex aortic endografts however long-term outcome data are needed.