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In situ Laser Fenestration of Visceral Endografts (InLoVE) : Midterm Outcomes from a Multicentre Study

Jónsson, Gísli G. ; Zielinski, Alexander H. ; Berczeli, Marton LU orcid ; Resch, Timothy A. LU ; Dias, Nuno LU orcid ; Wanhainen, Anders ; Mani, Kevin ; Ghulam, Qasam ; Karelis, Angelos LU orcid and Lindström, David (2025) In European journal of vascular and endovascular surgery 69(5). p.715-722
Abstract

Objective: Emergency complex abdominal aortic diseases are challenging to treat. During in situ laser fenestration (ISLF), aortic branches are covered and flow is restored by in situ fenestration of the stent graft, with promising midterm results. This study aimed to expand on the limited body of knowledge of midterm outcomes of ISLF in renovisceral aortic pathology in a multicentre setting. Methods: Retrospective pooled data on consecutive ISLF cases of visceral aortic stent grafts undertaken between 2018 – 2023 in three aortic centres were analysed. Technical success was defined as successful vascularisation with a bridging stent graft and acceptable final angiographic images without signs of endoleak related to the bridging stent... (More)

Objective: Emergency complex abdominal aortic diseases are challenging to treat. During in situ laser fenestration (ISLF), aortic branches are covered and flow is restored by in situ fenestration of the stent graft, with promising midterm results. This study aimed to expand on the limited body of knowledge of midterm outcomes of ISLF in renovisceral aortic pathology in a multicentre setting. Methods: Retrospective pooled data on consecutive ISLF cases of visceral aortic stent grafts undertaken between 2018 – 2023 in three aortic centres were analysed. Technical success was defined as successful vascularisation with a bridging stent graft and acceptable final angiographic images without signs of endoleak related to the bridging stent graft. Target vessel instability was defined as an endoleak related to the bridging stent graft, disconnection, kink, stenosis, occlusion of bridging stent, re-intervention to the bridging stent graft, or rupture or death related to the bridging stent graft. Results: Sixtyfive ISLFs were performed in 34 patients, with a mean age 74 years. The procedure was acute in 79%, and 35% were ruptures. Pre-stenting was performed on 56 target vessels (86%). Four patients (12%) died within 30 days; all presented with a rupture. Technical success was achieved in 61 of 65 (94%) ISLFs. All failed cannulations were in the renal arteries: three due to difficult angulations and one dissected during cannulation. Median follow up was 16 (interquartile range 5, 22) months. Cumulative survival at six months, one, and two years was 88%, 81%, and 72%, respectively. Six (10%) target vessel instabilities were detected: two (3%) type III endoleaks and four (7%) stent stenosis; all of which required re-lining. Freedom from target vessel instability at six months until the end of follow up was 89%. On the latest follow up scan, all successfully deployed ISLF bridging stents were patent (primary assisted patency 100%; 61 of 61) without signs of type III endoleak. Conclusion: ISLF is a promising tool for emergency endovascular procedures in complex anatomies.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Endovascular aortic repair, In situ, Laser fenestration, Paravisceral aortic aneurysm, Thoraco-abdominal aneurysm
in
European journal of vascular and endovascular surgery
volume
69
issue
5
pages
8 pages
publisher
Elsevier
external identifiers
  • pmid:39746568
  • scopus:85219068842
ISSN
1078-5884
DOI
10.1016/j.ejvs.2024.12.041
language
English
LU publication?
yes
id
0910cd86-94c0-429e-940b-03a304b81166
date added to LUP
2025-06-30 11:37:46
date last changed
2025-07-01 03:22:47
@article{0910cd86-94c0-429e-940b-03a304b81166,
  abstract     = {{<p>Objective: Emergency complex abdominal aortic diseases are challenging to treat. During in situ laser fenestration (ISLF), aortic branches are covered and flow is restored by in situ fenestration of the stent graft, with promising midterm results. This study aimed to expand on the limited body of knowledge of midterm outcomes of ISLF in renovisceral aortic pathology in a multicentre setting. Methods: Retrospective pooled data on consecutive ISLF cases of visceral aortic stent grafts undertaken between 2018 – 2023 in three aortic centres were analysed. Technical success was defined as successful vascularisation with a bridging stent graft and acceptable final angiographic images without signs of endoleak related to the bridging stent graft. Target vessel instability was defined as an endoleak related to the bridging stent graft, disconnection, kink, stenosis, occlusion of bridging stent, re-intervention to the bridging stent graft, or rupture or death related to the bridging stent graft. Results: Sixtyfive ISLFs were performed in 34 patients, with a mean age 74 years. The procedure was acute in 79%, and 35% were ruptures. Pre-stenting was performed on 56 target vessels (86%). Four patients (12%) died within 30 days; all presented with a rupture. Technical success was achieved in 61 of 65 (94%) ISLFs. All failed cannulations were in the renal arteries: three due to difficult angulations and one dissected during cannulation. Median follow up was 16 (interquartile range 5, 22) months. Cumulative survival at six months, one, and two years was 88%, 81%, and 72%, respectively. Six (10%) target vessel instabilities were detected: two (3%) type III endoleaks and four (7%) stent stenosis; all of which required re-lining. Freedom from target vessel instability at six months until the end of follow up was 89%. On the latest follow up scan, all successfully deployed ISLF bridging stents were patent (primary assisted patency 100%; 61 of 61) without signs of type III endoleak. Conclusion: ISLF is a promising tool for emergency endovascular procedures in complex anatomies.</p>}},
  author       = {{Jónsson, Gísli G. and Zielinski, Alexander H. and Berczeli, Marton and Resch, Timothy A. and Dias, Nuno and Wanhainen, Anders and Mani, Kevin and Ghulam, Qasam and Karelis, Angelos and Lindström, David}},
  issn         = {{1078-5884}},
  keywords     = {{Endovascular aortic repair; In situ; Laser fenestration; Paravisceral aortic aneurysm; Thoraco-abdominal aneurysm}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{715--722}},
  publisher    = {{Elsevier}},
  series       = {{European journal of vascular and endovascular surgery}},
  title        = {{In situ Laser Fenestration of Visceral Endografts (InLoVE) : Midterm Outcomes from a Multicentre Study}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2024.12.041}},
  doi          = {{10.1016/j.ejvs.2024.12.041}},
  volume       = {{69}},
  year         = {{2025}},
}