Kathryn DiLosa, Rohini J Patel, Asma Mathlouthi, Sina Zarrintan, Mahmoud Malas, Omar Al-Nouri, Andrew Barleben
{"title":"开窗和分支血管内主动脉修复的结果比较窄流腔与标准流腔的内脏旁主动脉段。","authors":"Kathryn DiLosa, Rohini J Patel, Asma Mathlouthi, Sina Zarrintan, Mahmoud Malas, Omar Al-Nouri, Andrew Barleben","doi":"10.1016/j.avsg.2025.09.016","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Fenestrated/branched endovascular aortic repair (F/BEVAR) with commercially available devices require a paravisceral segment >20 mm. We compared commercial and physician modified F/BEVAR outcomes in a narrowed flow lumen (NFL, <20 mm) to a standard flow lumen (SFL, ≥20 mm).</p><p><strong>Methods: </strong>We conducted a retrospective review of F/BEVAR repairs between 2016-2024. Primary outcome was technical success and secondary endpoints were target vessel stability, type 1/3 endoleaks requiring reintervention, and major adverse events (MAE).</p><p><strong>Results: </strong>A total of 136 patients underwent 138 repairs (75% male, 74±10 years), 35 repairs (25%) were in NFL and 103 (75%) in SFL. Median visceral segment diameter was 24 mm (IQR 19-29; 16mm, IQR 15-18 in NFL; 28mm, IQR 23-30 in SFL, p<.001). We observed 99% technical success. Mean fenestrations per repair was higher in NFL (3.1 vs 1.5, p<.001), and mean branches was higher in SFL (2.1 vs 0.7, p<.001). There were 24 (17%; 2 in NFL, 22 in SFL, p=.035) MAEs. There were nine branch vessel occlusions (three in NFL, six in SFL, p=.463) at a median follow up of 516 days. Target vessel stability (86% in NFL vs 84% in SFL, p=.757) and rate of reinterventions (2, 6% in NFL, 14, 14% in SFL, p=.209) did not differ significantly.</p><p><strong>Conclusions: </strong>Custom F/BEVAR offers equivalent outcomes in complex anatomy with narrowed paravisceral flow lumens compared to on-label branched and fenestrated repairs in standard flow lumens. Early results demonstrate reasonable target vessel stability and freedom from reintervention, though additional follow up is needed.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes in Fenestrated and Branched Endovascular Aortic Repair Comparing Patients with Narrow Flow Lumen versus Standard Flow Lumen of the Paravisceral Aortic Segment.\",\"authors\":\"Kathryn DiLosa, Rohini J Patel, Asma Mathlouthi, Sina Zarrintan, Mahmoud Malas, Omar Al-Nouri, Andrew Barleben\",\"doi\":\"10.1016/j.avsg.2025.09.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Fenestrated/branched endovascular aortic repair (F/BEVAR) with commercially available devices require a paravisceral segment >20 mm. We compared commercial and physician modified F/BEVAR outcomes in a narrowed flow lumen (NFL, <20 mm) to a standard flow lumen (SFL, ≥20 mm).</p><p><strong>Methods: </strong>We conducted a retrospective review of F/BEVAR repairs between 2016-2024. Primary outcome was technical success and secondary endpoints were target vessel stability, type 1/3 endoleaks requiring reintervention, and major adverse events (MAE).</p><p><strong>Results: </strong>A total of 136 patients underwent 138 repairs (75% male, 74±10 years), 35 repairs (25%) were in NFL and 103 (75%) in SFL. Median visceral segment diameter was 24 mm (IQR 19-29; 16mm, IQR 15-18 in NFL; 28mm, IQR 23-30 in SFL, p<.001). We observed 99% technical success. Mean fenestrations per repair was higher in NFL (3.1 vs 1.5, p<.001), and mean branches was higher in SFL (2.1 vs 0.7, p<.001). There were 24 (17%; 2 in NFL, 22 in SFL, p=.035) MAEs. There were nine branch vessel occlusions (three in NFL, six in SFL, p=.463) at a median follow up of 516 days. Target vessel stability (86% in NFL vs 84% in SFL, p=.757) and rate of reinterventions (2, 6% in NFL, 14, 14% in SFL, p=.209) did not differ significantly.</p><p><strong>Conclusions: </strong>Custom F/BEVAR offers equivalent outcomes in complex anatomy with narrowed paravisceral flow lumens compared to on-label branched and fenestrated repairs in standard flow lumens. Early results demonstrate reasonable target vessel stability and freedom from reintervention, though additional follow up is needed.</p>\",\"PeriodicalId\":8061,\"journal\":{\"name\":\"Annals of vascular surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-09-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of vascular surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.avsg.2025.09.016\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2025.09.016","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Outcomes in Fenestrated and Branched Endovascular Aortic Repair Comparing Patients with Narrow Flow Lumen versus Standard Flow Lumen of the Paravisceral Aortic Segment.
Objectives: Fenestrated/branched endovascular aortic repair (F/BEVAR) with commercially available devices require a paravisceral segment >20 mm. We compared commercial and physician modified F/BEVAR outcomes in a narrowed flow lumen (NFL, <20 mm) to a standard flow lumen (SFL, ≥20 mm).
Methods: We conducted a retrospective review of F/BEVAR repairs between 2016-2024. Primary outcome was technical success and secondary endpoints were target vessel stability, type 1/3 endoleaks requiring reintervention, and major adverse events (MAE).
Results: A total of 136 patients underwent 138 repairs (75% male, 74±10 years), 35 repairs (25%) were in NFL and 103 (75%) in SFL. Median visceral segment diameter was 24 mm (IQR 19-29; 16mm, IQR 15-18 in NFL; 28mm, IQR 23-30 in SFL, p<.001). We observed 99% technical success. Mean fenestrations per repair was higher in NFL (3.1 vs 1.5, p<.001), and mean branches was higher in SFL (2.1 vs 0.7, p<.001). There were 24 (17%; 2 in NFL, 22 in SFL, p=.035) MAEs. There were nine branch vessel occlusions (three in NFL, six in SFL, p=.463) at a median follow up of 516 days. Target vessel stability (86% in NFL vs 84% in SFL, p=.757) and rate of reinterventions (2, 6% in NFL, 14, 14% in SFL, p=.209) did not differ significantly.
Conclusions: Custom F/BEVAR offers equivalent outcomes in complex anatomy with narrowed paravisceral flow lumens compared to on-label branched and fenestrated repairs in standard flow lumens. Early results demonstrate reasonable target vessel stability and freedom from reintervention, though additional follow up is needed.
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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