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Revista argentina de cardiología
On-line version ISSN 1850-3748
Abstract
FERREIRA, L. MARIANO; FERRER, MIGUEL; ALOY, LEONELA and MURA, A. RICARDO LA. Endovascular treatment of aneurysms with complex aortic anatomy. Rev. argent. cardiol. [online]. 2023, vol.91, n.4, pp.278-283. Epub Aug 01, 2023. ISSN 1850-3748. http://dx.doi.org/10.7775/rac.es.v91.i4.20561.
Background:
Arterial anatomy is the main limiting factor for standard endovascular aortic (EVAR) approach. We present our experience for endovascular repair of complex aortic aneurysms.
Material and Methods:
This is a retrospective observational study in patients with complex aneurysms (juxta/pararenal and thoracoabdominal) treated consecutively with: fenestrated (FEVAR), branched (BEVAR), EndoAnchors (ESAR), or chimney (ChEVAR) stents. The decision of the technique was determined based on the arterial anatomy.
Results:
The last 50 procedures were evaluated (6 women; mean age 71.3 years; diameter 69.6 mm; and 3 patients with complicated aneurysms), among whom 22 received FEVAR (2.8 fenestrated stents/patient), 11 BEVAR, 11 ESAR and 6 ChEVAR (1.8 chimney stents/patient). Technical success rate was 100% (absence of type I or III endoleak with adequate patency of the visceral vessels). Three patients died within the first 30 days (6%). During follow-up, 5 patients presented with renal artery occlusion, treated successfully in 4 cases. Four patients developed type IA endoleak (3 secondary ESAR and one ChEVAR), one patient IC endoleak and almost a quarter of cases type IIIB endoleak (22%, 3 out of 11 patients receiving ESAR, none of the industrial FEVAR group). In survival analysis, overall survival analysis was 88.6% at one year, and 86.5% of cases were free from reoperation.
Conclusions:
This is the first publication in our setting that shows a global approach to the patient with complex aortic aneurysm, according to the anatomical characteristics. These technologies already play a primary role in the treatment of these patients.
Keywords : Abdominal Aortic Aneurysm; Endovascular repair; Device modification; Durability; Long-term follow-up; Thoracoabdominal aneurysms; Juxtarenal aneurysms; Complex Aorta.