Urgent and Emergent Repair of Complex Aortic Aneurysms Using an Off-the-shelf Branched Device

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Oct 9

PMID 37808886

Authors

Petroula Nana

Konstantinos Spanos

Tomasz Jakimowicz

Jose I Torrealba

Katarzyna Jama

Giuseppe Panuccio

Fiona Rohlffs

Tilo Kolbel

Affiliations

Soon will be listed here.

Abstract

Introduction: Endovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft.

Methods: Prospectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed.

Results: 225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I-III TAAAs. Females ( = .03), para-renal aneurysms ( = .02) and ASA score IV ( < .001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, (4.8% paraplegia rate) with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs. 26.7%, = .04) and MAE (26.0% vs. 43.0%, = .02) were more common among emergent cases while technical success (97.6% vs. 98.3%, = .9), and SCI (13.3% vs. 18.3%, = .4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, = 0.96).

Conclusion: T-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates.

Citing Articles

Endovascular Repair of Ruptured Abdominal Aortic Aneurysms Using the Endurant™ Endograft.

Nana P, Volakakis G, Spanos K, Kouvelos G, Bareka M, Arnaoutoglou E J Clin Med. 2024; 13(17).

PMID: 39274495 PMC: 11396500. DOI: 10.3390/jcm13175282.

References

Jordan F, FitzGibbon B, Kavanagh E, McHugh P, Veerasingam D, Sultan S . Endovascular versus open surgical repair for complicated chronic Type B aortic dissection. Cochrane Database Syst Rev. 2021; 12:CD012992. PMC: 8670553. DOI: 10.1002/14651858.CD012992.pub2. View

Luebke T, Brunkwall J . Risk-Adjusted Meta-analysis of 30-Day Mortality of Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysms. Ann Vasc Surg. 2015; 29(4):845-63. DOI: 10.1016/j.avsg.2014.12.014. View

Gallitto E, Faggioli G, Spath P, Pini R, Mascoli C, Logiacco A . Urgent endovascular repair of thoracoabdominal aneurysms using an off-the-shelf multibranched endograft. Eur J Cardiothorac Surg. 2021; 61(5):1087-1096. DOI: 10.1093/ejcts/ezab553. View

Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T . Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2018; 57(1):8-93. DOI: 10.1016/j.ejvs.2018.09.020. View

Ferrer C, Orrico M, Spataro C, Coscarella C, Ronchey S, Marino M . Outcomes of multibranched off-the-shelf stent graft in elective and urgent/emergent repair of complex aortic aneurysms with narrow internal aortic lumen. J Vasc Surg. 2022; 76(2):326-334. DOI: 10.1016/j.jvs.2022.03.007. View

Moulakakis K, Karaolanis G, Antonopoulos C, Kakisis J, Klonaris C, Preventza O . Open repair of thoracoabdominal aortic aneurysms in experienced centers. J Vasc Surg. 2018; 68(2):634-645.e12. DOI: 10.1016/j.jvs.2018.03.410. View

Kontopodis N, Galanakis N, Ioannou C, Tsetis D, Becquemin J, Antoniou G . Time-to-event data meta-analysis of late outcomes of endovascular versus open repair for ruptured abdominal aortic aneurysms. J Vasc Surg. 2021; 74(2):628-638.e4. DOI: 10.1016/j.jvs.2021.03.019. View

Georgiadis G, van Herwaarden J, Antoniou G, Hazenberg C, Giannoukas A, Lazarides M . Systematic Review of Off-the-Shelf or Physician-Modified Fenestrated and Branched Endografts. J Endovasc Ther. 2015; 23(1):98-109. DOI: 10.1177/1526602815611887. View

Bannazadeh M, Beckerman W, Korayem A, McKinsey J . Two-year evaluation of fenestrated and parallel branch endografts for the treatment of juxtarenal, suprarenal, and thoracoabdominal aneurysms at a single institution. J Vasc Surg. 2019; 71(1):15-22. DOI: 10.1016/j.jvs.2019.03.058. View

10.

Riambau V, Bockler D, Brunkwall J, Cao P, Chiesa R, Coppi G . Editor's Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017; 53(1):4-52. DOI: 10.1016/j.ejvs.2016.06.005. View

11.

Oderich G, Forbes T, Chaer R, Davies M, Lindsay T, Mastracci T . Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries. J Vasc Surg. 2020; 73(1S):4S-52S. DOI: 10.1016/j.jvs.2020.06.011. View

12.

Nana P, Spanos K, Kolbel T, Panuccio G, Jama K, Jakimowicz T . Early and Mid-Term Outcomes of Females Treated with t-Branch off the Shelf Device. Ann Vasc Surg. 2023; 95:32-41. DOI: 10.1016/j.avsg.2023.05.033. View

13.

Wang L, Locham S, Al-Nouri O, Eagleton M, Clouse W, Malas M . Endovascular repair of ruptured abdominal aortic aneurysm is superior to open repair: Propensity-matched analysis in the Vascular Quality Initiative. J Vasc Surg. 2020; 72(2):498-507. DOI: 10.1016/j.jvs.2019.11.063. View

14.

Gallitto E, Faggioli G, Pini R, Mascoli C, Freyrie A, Vento V . Total Endovascular Repair of Contained Ruptured Thoracoabdominal Aortic Aneurysms. Ann Vasc Surg. 2019; 58:211-221. DOI: 10.1016/j.avsg.2018.12.065. View

15.

Tsilimparis N, Heidemann F, Rohlffs F, Diener H, Wipper S, Sebastian Debus E . Outcome of Surgeon-Modified Fenestrated/Branched Stent-Grafts for Symptomatic Complex Aortic Pathologies or Contained Rupture. J Endovasc Ther. 2017; 24(6):825-832. DOI: 10.1177/1526602817729673. View

16.

Bilman V, Rinaldi E, Loschi D, Sheick-Yousif B, Melissano G . Suitability of current off-the-shelf devices for endovascular TAAA repair: a systematic review. J Cardiovasc Surg (Torino). 2023; 64(5):459-469. DOI: 10.23736/S0021-9509.23.12704-2. View

17.

Locatelli F, Nana P, Le Houerou T, Guirimand A, Nader M, Gaudin A . Spinal cord ischemia rates and prophylactic spinal drainage in patients treated with fenestrated/branched endovascular repair for thoracoabdominal aneurysms. J Vasc Surg. 2023; 78(4):883-891.e1. DOI: 10.1016/j.jvs.2023.06.002. View

18.

Alsusa H, Shahid A, Antoniou G . A comparison of endovascular versus open repair for ruptured abdominal aortic aneurysm - Meta-analysis of propensity score-matched data. Vascular. 2021; 30(4):628-638. DOI: 10.1177/17085381211025168. View

19.

Eleshra A, Hatm M, Spanos K, Panuccio G, Rohlffs F, Sebastian Debus E . Early outcomes of t-Branch off-the-shelf multibranched stent graft in urgent and emergent repair of thoracoabdominal aortic aneurysms. J Vasc Surg. 2021; 75(2):416-424.e2. DOI: 10.1016/j.jvs.2021.07.237. View

20.

Alberga A, von Meijenfeldt G, Rastogi V, de Bruin J, Wever J, van Herwaarden J . Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms: A Nationwide Cohort Study. Ann Surg. 2021; . DOI: 10.1097/SLA.0000000000005337. View