Marine Bordet, Mohammed Alkhani, Nellie Della-Schiava, Matthieu Arsicot, Alexandre Oliny, Antoine Millon
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Outcomes analysed included technical success (TS), procedure related death, occurrence of major adverse events (MAEs) and target vessel instability (TVI), type Ia endoleak (T1aEL), abdominal aortic aneurysm (AAA) related re-interventions, sac changes, and death.</p><p><strong>Results: </strong>Two hundred and ten patients were treated with the Anaconda stent graft. The mean AAA diameter was 60.4 ± 9.4 mm, with a mean of 3.9 ± 0.6 fenestrations per patient for a total of 816 target vessels (TVs). TS was 96.2% (202/210), MAEs occurred in 6.2% of patients (13/210), and procedure related mortality was 2.9% (6/210). The mean follow up was 24.0 ± 18.3 months. AAA related re-intervention was necessary in 18.6% of patients. Primary and secondary TV patency at follow up were 97.1% (24/816) and 98.0% (16/816), respectively. Freedom from TVI at one, three, and five years was 95.5% (95% confidence interval [CI] 93.9 - 97.1%), 92.5% (95% CI 90.2 - 94.8%), and 91.7% (95% CI 89.0 - 94.4%), respectively. No T1aEL was observed during follow up. Estimated freedom from sac enlargement at one, three, and four years was 96.9% (95% CI 94.3 - 99.6%), 88.4% (95% CI 82.6 - 94.3%), and 82.8% (95% CI 74.1 - 91.6%), respectively. Estimated overall survival at one, three, and five years was 92.2% (95% CI 88.6 - 95.9%), 80.0% (95% CI 73.3 - 86.8%), and 71.6% (95% CI 62.1 - 81.0%), respectively, with one case (0.5%) of late aortic related death.</p><p><strong>Conclusion: </strong>Endovascular repair of complex abdominal or thoraco-abdominal aneurysms using the fenestrated Anaconda stent graft is safe and effective with a high TS and low procedure related mortality rate. The midterm results appear satisfactory in terms of sac evolution, with a low TVI rate. The need for re-intervention is acceptable and justifies the need for meticulous imaging follow up.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Midterm Outcomes of the Fenestrated Anaconda Stent Graft for Complex Aortic Aneurysm Repair: A Large, Single Centre, Retrospective Study.\",\"authors\":\"Marine Bordet, Mohammed Alkhani, Nellie Della-Schiava, Matthieu Arsicot, Alexandre Oliny, Antoine Millon\",\"doi\":\"10.1016/j.ejvs.2025.03.033\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The aim of this study was to evaluate the short and midterm outcomes of the Anaconda fenestrated stent graft for the treatment of complex abdominal and thoraco-abdominal aneurysms.</p><p><strong>Methods: </strong>This was a retrospective study in a single academic centre. All patients consecutively treated with a fenestrated Anaconda device between January 2019 and May 2024 were included. Outcomes analysed included technical success (TS), procedure related death, occurrence of major adverse events (MAEs) and target vessel instability (TVI), type Ia endoleak (T1aEL), abdominal aortic aneurysm (AAA) related re-interventions, sac changes, and death.</p><p><strong>Results: </strong>Two hundred and ten patients were treated with the Anaconda stent graft. The mean AAA diameter was 60.4 ± 9.4 mm, with a mean of 3.9 ± 0.6 fenestrations per patient for a total of 816 target vessels (TVs). TS was 96.2% (202/210), MAEs occurred in 6.2% of patients (13/210), and procedure related mortality was 2.9% (6/210). The mean follow up was 24.0 ± 18.3 months. AAA related re-intervention was necessary in 18.6% of patients. Primary and secondary TV patency at follow up were 97.1% (24/816) and 98.0% (16/816), respectively. Freedom from TVI at one, three, and five years was 95.5% (95% confidence interval [CI] 93.9 - 97.1%), 92.5% (95% CI 90.2 - 94.8%), and 91.7% (95% CI 89.0 - 94.4%), respectively. No T1aEL was observed during follow up. Estimated freedom from sac enlargement at one, three, and four years was 96.9% (95% CI 94.3 - 99.6%), 88.4% (95% CI 82.6 - 94.3%), and 82.8% (95% CI 74.1 - 91.6%), respectively. Estimated overall survival at one, three, and five years was 92.2% (95% CI 88.6 - 95.9%), 80.0% (95% CI 73.3 - 86.8%), and 71.6% (95% CI 62.1 - 81.0%), respectively, with one case (0.5%) of late aortic related death.</p><p><strong>Conclusion: </strong>Endovascular repair of complex abdominal or thoraco-abdominal aneurysms using the fenestrated Anaconda stent graft is safe and effective with a high TS and low procedure related mortality rate. The midterm results appear satisfactory in terms of sac evolution, with a low TVI rate. 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引用次数: 0
摘要
目的：本研究的目的是评估Anaconda开窗支架移植治疗复杂腹部和胸腹动脉瘤的短期和中期疗效。方法：这是一项在单一学术中心进行的回顾性研究。纳入2019年1月至2024年5月期间连续使用开窗Anaconda装置治疗的所有患者。结果分析包括技术成功（TS）、手术相关死亡、主要不良事件（MAEs）和靶血管不稳定（TVI）、Ia型内漏（T1aEL）、腹主动脉瘤（AAA）相关再干预、囊腔改变和死亡。结果：210例患者接受了水蟒支架移植。平均AAA直径为60.4±9.4 mm，平均3.9±0.6个开窗/例，共有816个靶血管（TVs）。TS为96.2% (202/210)，MAEs发生率为6.2%(13/210)，手术相关死亡率为2.9%（6/210）。平均随访24.0±18.3个月。18.6%的患者需要AAA相关的再干预。随访时主次电视通畅率分别为97.1%（24/816）和98.0%（16/816）。1年、3年和5年的TVI自由度分别为95.5%（95%可信区间[CI] 93.9 - 97.1%）、92.5% （95% CI 90.2 - 94.8%）和91.7% （95% CI 89.0 - 94.4%）。随访期间未见t1el。估计1年、3年和4年囊增大的自由度分别为96.9% （95% CI 94.3 - 99.6%）、88.4% （95% CI 82.6 - 94.3%）和82.8% （95% CI 74.1 - 91.6%）。估计1年、3年和5年的总生存率分别为92.2% （95% CI 88.6 - 95.9%）、80.0% （95% CI 73.3 - 86.8%）和71.6% (95% CI 62.1 - 81.0%)，其中一例（0.5%）为晚期主动脉相关死亡。结论：开窗Anaconda支架修复复杂腹腔或胸腹动脉瘤安全有效，TS高，手术相关死亡率低。中期结果在囊演变方面令人满意，TVI率低。再次介入治疗的需要是可以接受的，并证明需要细致的影像学随访。
Midterm Outcomes of the Fenestrated Anaconda Stent Graft for Complex Aortic Aneurysm Repair: A Large, Single Centre, Retrospective Study.
Objective: The aim of this study was to evaluate the short and midterm outcomes of the Anaconda fenestrated stent graft for the treatment of complex abdominal and thoraco-abdominal aneurysms.
Methods: This was a retrospective study in a single academic centre. All patients consecutively treated with a fenestrated Anaconda device between January 2019 and May 2024 were included. Outcomes analysed included technical success (TS), procedure related death, occurrence of major adverse events (MAEs) and target vessel instability (TVI), type Ia endoleak (T1aEL), abdominal aortic aneurysm (AAA) related re-interventions, sac changes, and death.
Results: Two hundred and ten patients were treated with the Anaconda stent graft. The mean AAA diameter was 60.4 ± 9.4 mm, with a mean of 3.9 ± 0.6 fenestrations per patient for a total of 816 target vessels (TVs). TS was 96.2% (202/210), MAEs occurred in 6.2% of patients (13/210), and procedure related mortality was 2.9% (6/210). The mean follow up was 24.0 ± 18.3 months. AAA related re-intervention was necessary in 18.6% of patients. Primary and secondary TV patency at follow up were 97.1% (24/816) and 98.0% (16/816), respectively. Freedom from TVI at one, three, and five years was 95.5% (95% confidence interval [CI] 93.9 - 97.1%), 92.5% (95% CI 90.2 - 94.8%), and 91.7% (95% CI 89.0 - 94.4%), respectively. No T1aEL was observed during follow up. Estimated freedom from sac enlargement at one, three, and four years was 96.9% (95% CI 94.3 - 99.6%), 88.4% (95% CI 82.6 - 94.3%), and 82.8% (95% CI 74.1 - 91.6%), respectively. Estimated overall survival at one, three, and five years was 92.2% (95% CI 88.6 - 95.9%), 80.0% (95% CI 73.3 - 86.8%), and 71.6% (95% CI 62.1 - 81.0%), respectively, with one case (0.5%) of late aortic related death.
Conclusion: Endovascular repair of complex abdominal or thoraco-abdominal aneurysms using the fenestrated Anaconda stent graft is safe and effective with a high TS and low procedure related mortality rate. The midterm results appear satisfactory in terms of sac evolution, with a low TVI rate. The need for re-intervention is acceptable and justifies the need for meticulous imaging follow up.
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.
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