Low Profile Off the Shelf Multibranched Endografts for Urgent Endovascular Repair of Complex Aortic and Thoraco-abdominal Aneurysms in Patients with Hostile Iliac Access: European Multicentre Observational Study

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2025-03-01 DOI:10.1016/j.ejvs.2024.10.032

Enrico Gallitto , Gioele Simonte , Vincent Fointain , Andrea Kahlberg , Giacomo Isernia , Germano Melissano , Fabrizio Cecere , Gianbattista Parlani , Stephan Haulon , Mauro Gargiulo

{"title":"Low Profile Off the Shelf Multibranched Endografts for Urgent Endovascular Repair of Complex Aortic and Thoraco-abdominal Aneurysms in Patients with Hostile Iliac Access: European Multicentre Observational Study","authors":"Enrico Gallitto , Gioele Simonte , Vincent Fointain , Andrea Kahlberg , Giacomo Isernia , Germano Melissano , Fabrizio Cecere , Gianbattista Parlani , Stephan Haulon , Mauro Gargiulo","doi":"10.1016/j.ejvs.2024.10.032","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The aim of the study was to report outcomes of a thoraco-abdominal, custom made, low profile (outer diameter 20 F) four branched endograft used as an off the shelf (OTS) solution for urgent juxta- and pararenal abdominal aortic aneurysms (JP-AAAs) and thoraco-abdominal aortic aneurysms (TAAAs) in the presence of hostile femoral or iliac access.</div></div><div><h3>Methods</h3><div>Data for patients who underwent endovascular repair for urgent JP-AAAs and TAAAs with hostile femoral or iliac access by a low profile, four branched endograft in four European aortic centres between 2019 and 2023 were collected prospectively and analysed retrospectively. The investigated device was a custom made endograft with the configuration of a standard t-Branch, used as an OTS solution for urgent cases with hostile femoral or iliac access. Access related complications, spinal cord ischaemia (SCI), and 30 day death were assessed as primary outcomes. Survival, freedom from re-interventions (FFRs), and iliac limb occlusion (ILO) were evaluated as secondary outcomes.</div></div><div><h3>Results</h3><div>Fifty five cases were enrolled: ruptures, <em>n =</em> 14 (25%); symptomatic, <em>n =</em> 12 (22%); and asymptomatic TAAAs with diameter ≥ 80 mm, <em>n =</em> 29 (53%). There were seven (13%) JP-AAAs and 48 (87%) TAAAs. The median right and left external iliac artery diameters were 6.7 (interquartile range [IQR] 5.5, 7.9) mm and 7.1 (IQR 6.5, 8.7) mm, respectively. Bilateral hostile femoral or iliac access was reported in 39 patients (71%). Access related complications occurred in five cases (9%). There were four cases (7%) of SCI with two permanent paraplegias. Four patients (7%) died within 30 days. The median follow up was 22 (IQR 11, 33) months. Overall, eight patients (15%) required re-interventions: four within 30 days and four during follow up. No ILO occurred. Estimated one year FFRs and survival were 91% and 87%, respectively.</div></div><div><h3>Conclusion</h3><div>Low profile OTS thoraco-abdominal endografts seems safe and effective to manage urgent JP-AAAs and TAAAs in the presence of hostile femoral or iliac access. Further larger studies with long term follow up are needed to validate this preliminary experience.</div></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 371-379"},"PeriodicalIF":5.7000,"publicationDate":"2025-03-01","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://www.sciencedirect.com/science/article/pii/S1078588424009079","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

The aim of the study was to report outcomes of a thoraco-abdominal, custom made, low profile (outer diameter 20 F) four branched endograft used as an off the shelf (OTS) solution for urgent juxta- and pararenal abdominal aortic aneurysms (JP-AAAs) and thoraco-abdominal aortic aneurysms (TAAAs) in the presence of hostile femoral or iliac access.

Methods

Data for patients who underwent endovascular repair for urgent JP-AAAs and TAAAs with hostile femoral or iliac access by a low profile, four branched endograft in four European aortic centres between 2019 and 2023 were collected prospectively and analysed retrospectively. The investigated device was a custom made endograft with the configuration of a standard t-Branch, used as an OTS solution for urgent cases with hostile femoral or iliac access. Access related complications, spinal cord ischaemia (SCI), and 30 day death were assessed as primary outcomes. Survival, freedom from re-interventions (FFRs), and iliac limb occlusion (ILO) were evaluated as secondary outcomes.

Results

Fifty five cases were enrolled: ruptures, n = 14 (25%); symptomatic, n = 12 (22%); and asymptomatic TAAAs with diameter ≥ 80 mm, n = 29 (53%). There were seven (13%) JP-AAAs and 48 (87%) TAAAs. The median right and left external iliac artery diameters were 6.7 (interquartile range [IQR] 5.5, 7.9) mm and 7.1 (IQR 6.5, 8.7) mm, respectively. Bilateral hostile femoral or iliac access was reported in 39 patients (71%). Access related complications occurred in five cases (9%). There were four cases (7%) of SCI with two permanent paraplegias. Four patients (7%) died within 30 days. The median follow up was 22 (IQR 11, 33) months. Overall, eight patients (15%) required re-interventions: four within 30 days and four during follow up. No ILO occurred. Estimated one year FFRs and survival were 91% and 87%, respectively.

Conclusion

Low profile OTS thoraco-abdominal endografts seems safe and effective to manage urgent JP-AAAs and TAAAs in the presence of hostile femoral or iliac access. Further larger studies with long term follow up are needed to validate this preliminary experience.

查看原文本刊更多论文

低剖面现成多分支内移植物用于有敌对髂动脉通路患者的复杂主动脉瘤和胸腹腔动脉瘤的紧急血管内修复：欧洲多中心观察研究。

研究目的该研究旨在报告一种胸腹腔定制的低剖面（外径 20 Fr）四分支内移植物的疗效，该内移植物作为一种现成的（OTS）解决方案，用于治疗股骨/髂骨入路不畅情况下的紧急腹主动脉瘤（J/P-AAAs）和胸腹腔主动脉瘤（TAAAs）：在2019年至2023年期间，欧洲四家主动脉中心通过低剖面四分支内移植物，对股骨/髂骨入路不畅的J/P-AAAs和TAAAs急诊患者进行了血管内修复，对这些患者的数据进行了前瞻性收集和回顾性分析。所研究的装置是一种定制的内植物，具有标准T型分支的结构，作为OTS解决方案用于股骨/髂骨入路不畅的急诊病例。与入路相关的并发症、脊髓缺血（SCI）和 30 天死亡率是评估的主要结果。存活率、免于再次介入（FFR）和髂肢闭塞（ILO）是次要评估结果：55例病例：破裂，14例（25%）；无症状，12例（22%）；直径≥80毫米的无症状TAAA，29例（53%）。J/P-AAAs有7例（13%），TAAAs有48例（87%）。右侧和左侧髂外动脉直径的中位数分别为6.7（四分位距[IQR] 5.5，7.9）毫米和7.1（IQR 6.5，8.7）毫米。39例患者（71%）报告了双侧股骨/髂骨敌对入路。5例（9%）患者出现了与入路相关的并发症。有四例（7%）出现 SCI，其中两例为永久性截瘫。四名患者（7%）在 30 天内死亡。中位随访时间为22个月（IQR为11-33）。总体而言，有八名患者（15%）需要再次进行干预：四名在 30 天内，四名在随访期间。没有发生 ILO。估计的一年FFR和存活率分别为91%和87%：低位OTS胸腹腔内移植物对于处理股骨/髂骨入路不畅的紧急J/P-AAAs和TAAAs似乎安全有效。要验证这一初步经验，还需要进行更大规模的长期随访研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

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.