Anastasia Dean, Summer Hassan, William Yoon, Kevin Mani, Anders Wanhainen, David Lindström
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引用次数: 0
Abstract
Background: Endovascular repair of thoracoabdominal and pararenal aortic aneurysms (TAAAs and PAAAs) involves the use of branched stent grafts to perfuse visceral arteries. Non-standard renal branch configuration, such as "ballerina," may be required as a bailout technique in challenging anatomical or technical situations. This configuration may result in altered hemodynamic stress, increasing the risk of branch-related complications.
Methods: This single-center, retrospective cohort study analyzed outcomes of renal branches in standard and non-standard configurations (outside IFU) following endovascular repair of TAAAs and PAAAs. Renal branches were categorized as standard or ballerina (branch connected to the contralateral renal artery, ≥90° radial deviation from the cuff to the arterial orifice) based on postoperative imaging. Adverse outcomes, including branch occlusion, thrombus formation, and the need for re-intervention, were recorded. Kaplan-Meier analysis was used to assess complication-free survival.
Results: A total of 97 renal branches in 56 patients were analyzed and followed for a median of 25 months. Non-standard configuration (11 branches) had significantly higher adverse event rates (45%) compared to standard configurations (16%, p = 0.04). Complications among the eleven ballerina branches included two occlusions, one thrombus, and two compressions requiring re-lining. In standard configurations, branch occlusions were the most common complication (14%). Kaplan-Meier analysis demonstrated significantly reduced complication-free survival in non-standard configurations compared to standard configurations (median 54 vs 594 days, p = 0.02).
Conclusion: Bailout non-standard renal branch configurations are associated with a high rate of serious adverse events. Intensified postoperative imaging surveillance with readiness for re-intervention and optimized antithrombotic therapy should be considered in these cases.
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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