Enrico Gallitto, Gianluca Faggioli, Andrea Vacirca, Emanuel R Tenorio, Bernardo C Mendes, Marcello Lodato, Antonio Cappiello, Jesse Chait, Gustavo S Oderich, Mauro Gargiulo
{"title":"Hybrid Stent Graft Technique in Bridging Hostile Renal Arteries in Thoracoabdominal Branched Endografting.","authors":"Enrico Gallitto, Gianluca Faggioli, Andrea Vacirca, Emanuel R Tenorio, Bernardo C Mendes, Marcello Lodato, Antonio Cappiello, Jesse Chait, Gustavo S Oderich, Mauro Gargiulo","doi":"10.1016/j.ejvs.2024.10.008","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Patency of target arteries is crucial for fenestrated and branched endovascular aortic repair (F/B-EVAR) in thoracoabdominal aortic aneurysms (TAAAs). Occlusions more frequently occur in renal arteries (RAs) than in coeliac and superior mesenteric arteries, especially in patients with hostile anatomy treated by BEVAR. This study aimed to report RA outcomes using a hybrid bridging stent graft technique with distal self expandable (SE) combined with proximal balloon expandable (BE) stent graft during BEVAR with hostile RA anatomies.</p><p><strong>Methods: </strong>Clinical data from consecutive patients treated for TAAA by F/B-EVAR in three aortic centres (two in the USA, one in Europe) from 2016 to 2022 were prospectively collected. Renal artery orientation was defined as hostile in case of upward (type B) or downward + upward (type D) orientation. Hostile RAs accommodated by BEVAR and combination of SE + BE stent grafts were retrospectively evaluated. Intra-operative RA related complications, technical success, and branch occlusions were assessed as early outcomes. Primary and secondary RA patency, freedom from RA related re-interventions, and freedom from RA instability were assessed during follow up.</p><p><strong>Results: </strong>Of 584 TAAAs managed by F/B-EVAR, 83 patients (14.2%) had 125 hostile RAs (type B, 45.6%; type D, 54.4%) managed by BEVAR with hybrid SE + BE stent grafts. Intra-operative complications occurred in three RAs (2.4%), including two dissections and one disconnection, all successfully managed with additional stent. Technical success was achieved in all cases, with no RA occlusions at 30 days. The median follow up was 21 (interquartile range 4, 38) months. Estimated three year RA primary patency was 97 ± 2%. Re-interventions were performed in five RAs (4.0%), including two RA branch embolisations for bleeding, two catheter thrombectomies with stent relining (bilateral occlusion in one patient), and one revision of type Ic endoleak. Freedom from RA related re-interventions and RA instability was 95 ± 2% and 91 ± 3% at three years, respectively. Renal artery secondary patency was 99 ± 1% at three years.</p><p><strong>Conclusion: </strong>In hostile RA anatomies, a combination of distal SE and proximal BE stent grafts as bridging stenting in BEVAR is safe and effective, with low rates of occlusion, re-interventions, and branch instability at midterm follow up.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Vascular and Endovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ejvs.2024.10.008","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Patency of target arteries is crucial for fenestrated and branched endovascular aortic repair (F/B-EVAR) in thoracoabdominal aortic aneurysms (TAAAs). Occlusions more frequently occur in renal arteries (RAs) than in coeliac and superior mesenteric arteries, especially in patients with hostile anatomy treated by BEVAR. This study aimed to report RA outcomes using a hybrid bridging stent graft technique with distal self expandable (SE) combined with proximal balloon expandable (BE) stent graft during BEVAR with hostile RA anatomies.
Methods: Clinical data from consecutive patients treated for TAAA by F/B-EVAR in three aortic centres (two in the USA, one in Europe) from 2016 to 2022 were prospectively collected. Renal artery orientation was defined as hostile in case of upward (type B) or downward + upward (type D) orientation. Hostile RAs accommodated by BEVAR and combination of SE + BE stent grafts were retrospectively evaluated. Intra-operative RA related complications, technical success, and branch occlusions were assessed as early outcomes. Primary and secondary RA patency, freedom from RA related re-interventions, and freedom from RA instability were assessed during follow up.
Results: Of 584 TAAAs managed by F/B-EVAR, 83 patients (14.2%) had 125 hostile RAs (type B, 45.6%; type D, 54.4%) managed by BEVAR with hybrid SE + BE stent grafts. Intra-operative complications occurred in three RAs (2.4%), including two dissections and one disconnection, all successfully managed with additional stent. Technical success was achieved in all cases, with no RA occlusions at 30 days. The median follow up was 21 (interquartile range 4, 38) months. Estimated three year RA primary patency was 97 ± 2%. Re-interventions were performed in five RAs (4.0%), including two RA branch embolisations for bleeding, two catheter thrombectomies with stent relining (bilateral occlusion in one patient), and one revision of type Ic endoleak. Freedom from RA related re-interventions and RA instability was 95 ± 2% and 91 ± 3% at three years, respectively. Renal artery secondary patency was 99 ± 1% at three years.
Conclusion: In hostile RA anatomies, a combination of distal SE and proximal BE stent grafts as bridging stenting in BEVAR is safe and effective, with low rates of occlusion, re-interventions, and branch instability at midterm follow up.
目的：目标动脉的通畅对于胸腹主动脉瘤（TAAA）的栅栏式和分支式血管内主动脉修复术（F/B-EVAR）至关重要。与腹腔动脉和肠系膜上动脉相比，肾动脉（RA）更容易发生闭塞，尤其是在采用 BEVAR 治疗的解剖结构不良的患者中。本研究旨在报告在对解剖结构不利的 RA 进行 BEVAR 时，使用远端自膨胀（SE）结合近端球囊膨胀（BE）支架移植的混合桥接支架移植技术治疗 RA 的结果：前瞻性地收集了2016年至2022年在三个主动脉中心（两个在美国，一个在欧洲）通过F/B-EVAR治疗TAAA的连续患者的临床数据。肾动脉走向被定义为向上（B型）或向下+向上（D型）的敌对走向。对通过 BEVAR 和 SE + BE 支架移植物组合治疗的敌对 RA 进行了回顾性评估。术中与 RA 相关的并发症、技术成功率和分支闭塞作为早期结果进行评估。在随访过程中，对原发性和继发性RA通畅率、RA相关再干预的自由度以及RA不稳定性进行了评估：结果：在采用F/B-EVAR手术治疗的584例TAAA中，83例患者（14.2%）有125例敌对RA（B型，45.6%；D型，54.4%）采用混合SE+BE支架移植物的BEVAR手术治疗。3例RA（2.4%）发生了术中并发症，包括2例剥离和1例断开，均通过额外支架成功处理。所有病例均取得了技术成功，30 天内无 RA 闭塞。中位随访时间为 21 个月（四分位距为 4 到 38 个月）。据估计，RA三年的初次通畅率为97 ± 2%。对五例 RA（4.0%）进行了再次介入治疗，包括两次因出血而进行的 RA 分支栓塞术、两次导管血栓切除术和支架重衬术（一名患者为双侧闭塞），以及一次 Ic 型内漏修补术。三年内，RA相关再干预和RA不稳定的发生率分别为95±2%和91±3%。三年后，肾动脉二次通畅率为 99 ± 1%：在恶劣的RA解剖条件下，在BEVAR中结合使用远端SE和近端BE支架移植物作为桥接支架是安全有效的，在中期随访中，闭塞率、再介入率和分支不稳定率都很低。
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
