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Fenestrated Endovascular Repair using Short Tipped Distal Components with “No Cross” Concept to Prevent Crushing of Target Vessel Bridging Stents

Karelis, Angelos LU orcid ; Mohammed, Yasir LU orcid ; Oderich, Gustavo s. ; Sonesson, Björn LU and Dias, Nuno v. LU orcid (2024) In European journal of vascular and endovascular surgery
Abstract
Objective
To compare and evaluate early and midterm outcomes of a “no cross” novel approach with short tip vs. standard tip introducer systems for all distal components to prevent target vessel bridging stent kink or collapse during fenestrated endovascular aortic repair (FEVAR).
Methods
A retrospective analysis was conducted on all patients who underwent FEVAR at a tertiary referral centre between October 2016 and July 2022. The inclusion criterion was the use of renal artery fenestrations. Patients who had chronic dissections were included. Endpoints were analysed in two groups comprising the “no cross” group and the standard group, with all cases being consecutive in their respective groups. Cone beam computed tomography was... (More)
Objective
To compare and evaluate early and midterm outcomes of a “no cross” novel approach with short tip vs. standard tip introducer systems for all distal components to prevent target vessel bridging stent kink or collapse during fenestrated endovascular aortic repair (FEVAR).
Methods
A retrospective analysis was conducted on all patients who underwent FEVAR at a tertiary referral centre between October 2016 and July 2022. The inclusion criterion was the use of renal artery fenestrations. Patients who had chronic dissections were included. Endpoints were analysed in two groups comprising the “no cross” group and the standard group, with all cases being consecutive in their respective groups. Cone beam computed tomography was used intra-operatively in all cases, and post-operative compute tomography angiograms and re-interventions were reviewed. Primary endpoints included technical success, intra-operative adjunctive procedures, adverse events related to the fenestration, and re-interventions, while secondary endpoints were secondary interventions and overall mortality.
Results
A total of 70 patients (35 in each group) were enrolled in the study, with 64 (91%) having juxta-renal aneurysms. There were no differences in demographics, cardiovascular risk factors, or aneurysm characteristics between the two groups. The “no cross” group demonstrated a significantly higher technical success rate (100% in all cases) compared with the standard group (29 cases, 83%; p = .010). Additionally, there were statistically significantly fewer intra-operative adjunctive procedures required in the “no cross” group (1.5% of fenestrations) compared with the standard group (8.2% of fenestrations) (p = .013). Overall median follow up was 32 months (interquartile range 22, 62 months).
Conclusion
Implementation of a novel “no cross” concept during FEVAR, utilising a short dilator introducer tip on the distal bifurcated component and iliac extensions, significantly reduces intra-operative fenestration related adverse events and enhances technical success. Further studies with larger patient populations and longer follow up are needed to confirm these findings. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European journal of vascular and endovascular surgery
publisher
Elsevier
external identifiers
  • pmid:38876370
ISSN
1532-2165
DOI
10.1016/j.ejvs.2024.06.007
language
English
LU publication?
yes
id
7278a636-8150-4886-a652-8bf9afe99855
date added to LUP
2024-06-17 13:33:28
date last changed
2024-06-18 03:07:57
@article{7278a636-8150-4886-a652-8bf9afe99855,
  abstract     = {{Objective<br/>To compare and evaluate early and midterm outcomes of a “no cross” novel approach with short tip vs. standard tip introducer systems for all distal components to prevent target vessel bridging stent kink or collapse during fenestrated endovascular aortic repair (FEVAR).<br/>Methods<br/>A retrospective analysis was conducted on all patients who underwent FEVAR at a tertiary referral centre between October 2016 and July 2022. The inclusion criterion was the use of renal artery fenestrations. Patients who had chronic dissections were included. Endpoints were analysed in two groups comprising the “no cross” group and the standard group, with all cases being consecutive in their respective groups. Cone beam computed tomography was used intra-operatively in all cases, and post-operative compute tomography angiograms and re-interventions were reviewed. Primary endpoints included technical success, intra-operative adjunctive procedures, adverse events related to the fenestration, and re-interventions, while secondary endpoints were secondary interventions and overall mortality.<br/>Results<br/>A total of 70 patients (35 in each group) were enrolled in the study, with 64 (91%) having juxta-renal aneurysms. There were no differences in demographics, cardiovascular risk factors, or aneurysm characteristics between the two groups. The “no cross” group demonstrated a significantly higher technical success rate (100% in all cases) compared with the standard group (29 cases, 83%; p = .010). Additionally, there were statistically significantly fewer intra-operative adjunctive procedures required in the “no cross” group (1.5% of fenestrations) compared with the standard group (8.2% of fenestrations) (p = .013). Overall median follow up was 32 months (interquartile range 22, 62 months).<br/>Conclusion<br/>Implementation of a novel “no cross” concept during FEVAR, utilising a short dilator introducer tip on the distal bifurcated component and iliac extensions, significantly reduces intra-operative fenestration related adverse events and enhances technical success. Further studies with larger patient populations and longer follow up are needed to confirm these findings.}},
  author       = {{Karelis, Angelos and Mohammed, Yasir and Oderich, Gustavo s. and Sonesson, Björn and Dias, Nuno v.}},
  issn         = {{1532-2165}},
  language     = {{eng}},
  month        = {{06}},
  publisher    = {{Elsevier}},
  series       = {{European journal of vascular and endovascular surgery}},
  title        = {{Fenestrated Endovascular Repair using Short Tipped Distal Components with “No Cross” Concept to Prevent Crushing of Target Vessel Bridging Stents}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2024.06.007}},
  doi          = {{10.1016/j.ejvs.2024.06.007}},
  year         = {{2024}},
}